Perioral Dermatitis, Clarified

Perioral dermatitis is a skin condition that leads to a crimson, lumpy rash, typically around the mouth and sometimes around the nose or eyes, says Rajani Katta, M.D., a certified dermatologist, clinical professor at Baylor College of Medicine and the University of Texas Health Science Center at Houston, and author of Glow: The Dermatologist’s Guide to a Whole Foods Younger Skin Diet. (By the way, despite their resemblance, perioral dermatitis is not the same as keratosis pilaris.)

“Many of my patients describe it as ‘lumpy and scaly,’ because the rash typically consists of red bumps on a base of arid, flaky skin,” explains Dr. Katta. “And most patients will describe it as tender or susceptible to burning or stinging,” she adds. Ouch, correct? Even worse, more severe cases can involve pustules filled with pus or even miniature blisters.

The seriousness of perioral dermatitis can differ from individual to individual. For example, model Hailey Bieber revealed she deals with the skin condition in a Glamour UK interview, remarking that she experiences “a dreadful itchy rash around [her] mouth and eyes” when using certain products. An itchy rash as described by Bieber can be the extent of the outbreak, but more severe cases can involve inflamed pustules on the face. (An instance of the more extreme case? News anchor Frances Wang dealt with an intense outbreak of the condition and said that it was so painful that it hurt to converse or consume.)

While rash around the mouth, nose, and eyes is the most prevalent, perioral dermatitis can also appear around the genitals, according to the American Academy of Dermatology Association

Irrespective of its location, however, perioral dermatitis is non-transmissible.

The Reasons for Perioral Dermatitis

To be honest, dermatologists don’t precisely know what causes perioral dermatitis, says Patricia Farris, M.D., a certified dermatologist and founder of RegimenMD based in Metairie, Louisiana. It affects women much more than men, but experts say there are many unanswered questions about potential triggers, as they can vary from individual to individual.

One of the most common causes of perioral dermatitis is steroid cream (including prescription medications and over-the-counter hydrocortisone creams and ointments), explain Drs. Katta and Farris. Many individuals mistakenly use these creams on perioral dermatitis because they believe it will help clear up the rash, but it can actually worsen it, say the dermatologists.

Excessive use of night creams and moisturizers could also lead to perioral dermatitis, particularly if the products contain fragrances or certain ingredients that one is sensitive to, add Drs. Katta and Farris. Using fluoride toothpaste and occlusive ointments like petroleum jelly on the face may also play a role, notes Dr. Farris. For some people, hormonal changes or genetic factors may also be associated with perioral dermatitis, according to Dr. Katta.

Some doctors have observed cases of perioral dermatitis in individuals with a weak skin barrier, something that can make the skin more susceptible to inflammation in general, notes Dr. Katta. Researchers have also studied bacteria and yeast obtained from this rash, but they haven’t been able to determine if they’re actually the cause or simply present alongside the rash as other unwelcome visitors.

Interestingly, there are some theories that dairy and gluten may be contributing factors to perioral dermatitis, but there is insufficient research to support this, says Dr. Farris. “Additionally, other conditions can sometimes resemble perioral dermatitis,” says Dr. Katta. For instance, allergic contact dermatitis — an allergic reaction to certain ingredients in skincare products, or even certain foods — can trigger a similar red, flaky rash, she notes. Sometimes, foods such as cinnamon or tomatoes can trigger this type of allergic rash, which can be mistaken for perioral dermatitis if it appears around the lips and mouth, explains Dr. Katta.

The Optimal Treatment for Perioral Dermatitis

Unfortunately, experts state that there is no “cure” or quick solution for how to eliminate perioral dermatitis overnight. Many treatment approaches for perioral dermatitis involve experimenting with different medications before finding something that works.

So, the most favorable action you can take is consult a dermatologist for an accurate analysis and therapy.

In numerous instances, the most efficient treatments for perioral dermatitis are prescription medications that are either antimicrobial or anti-inflammatory, as stated by Dr. Katta, who adds that she usually prescribes medicated creams to begin with. However, please bear in mind: It can take weeks to months for the skin to improve, notes Dr. Katta. She mentions that she typically advises patients to try a prescription medicated cream for eight weeks before reassessing the situation. Flare-ups are common, so it’s crucial to keep in contact with your dermatologist and schedule follow-up appointments in case retreatment or switching to another medication is necessary, she explains. In more severe cases, oral medications may be required.

Regarding your skin-care routine, utilizing an excessive number of dense, oily products may potentially act as a trigger for some individuals, which is why it’s important to always eliminate your makeup at night, according to Dr. Katta. If you experience the stinging and burning sensation that is commonly associated with perioral dermatitis, avoiding fragrances would likely be beneficial as well, says Dr. Farris.

“I also consistently recommend continuing to cleanse your face, even if it appears dry,” explains Dr. Katta. Attempt using a hydrating cleanser like Cetaphil Gentle Skin Cleanser (Purchase It, $12, ulta.com) or a mild foaming cleanser like Cerave Foaming Facial Cleanser (Purchase It, $16, ulta.com), she suggests. “I also recommend applying moisturizer while the skin is still damp to help strengthen the skin barrier, as it may be advantageous in preventing outbreaks, although it is not a fundamental part of treatment,” adds Dr. Katta.

Perioral dermatitis can certainly be vexing, not to mention downright agonizing in some instances. However, the positive news is that it is not detrimental to your overall skin health (or general health). “[In] the long-term prognosis, most individuals will recover with treatment and then continue to fare well for a period of time,” says Dr. Katta. “However, it is fairly common to experience a recurrence of the rash at a later point. I always advise that even if you are following all the correct steps, you may still encounter perioral dermatitis,” she notes.

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