Perioral Dermatitis: Causes, Treatment, and Prevention
Dr. Angel Rivera
Perioral dermatitis is a common skin condition that occurs around the mouth. It often starts with red, inflamed patches and may then progress to lesions that resemble acne. Though it is not contagious, this can cause discomfort and embarrassment for sufferers as it can lead to conspicuous bumps, blisters, and redness on the skin. We will discuss perioral dermatitis causes, how the condition is diagnosed, treating perioral dermatitis, and how you can prevent perioral dermatitis in order to help you get your skin back on track.
What is perioral dermatitis?
Dermatitis is a broad term that is applied to any irritation of the skin. Perioral dermatitis, also known as periorificial dermatitis, is a common skin condition that often appears as red, scaly patches around the mouth. "Peri," in Greek, means around, while "oral" refers to your mouth so this means it is a type of dermatitis around the mouth. Perioral dermatitis can be uncomfortable due to its itchy or burning sensations, and may also cause soreness, swelling, and dry skin. There are many ways to treat perioral dermatitis, including topical ointments.
The name dermatitis can be a bit misleading as it is often associated with the three common types of dermatitis, atopic dermatitis which is more commonly called eczema, seborrheic dermatitis, and contact dermatitis. This can lead to confusion as perioral dermatitis is not eczematous, meaning something related to eczema.
Perioral dermatitis occurs when the skin around the mouth becomes inflamed due to an allergic or irritant reaction. The condition can also affect the area around the nostrils and less commonly the eyes or genitals. It may also be caused by rosacea, a type of chronic acne that often leads to redness. Perioral dermatitis is different from acne vulgaris, the most common form of acne.
What causes perioral dermatitis?
There are many different factors that may lead to the development of perioral dermatitis including allergies, acne medications such as isotretinoin, steroid withdrawal, oral contraceptives like birth control pills, or hormone replacement therapy. There is also a strong correlation between smoking cigarettes and developing an outbreak of this skin condition. It is speculated that cosmetics and moisturizers can play a role in its development too. It should be noted that there has not been one specific cause discovered for developing perioral dermatitis; it can develop due to a variety of reasons depending on the individual.
It is important to reiterate that the causes of perioral dermatitis are not fully known or understood. Please feel free to consult your medical professional should you have any further questions about what could be causing this condition for you.
What are the signs and symptoms?
There are several signs and symptoms that usually occur when you have perioral dermatitis. The most common are as follows:
- Redness around the mouth area, mainly on the skin surrounding your lips although the vermillion border, or the skin directly next to your lips, is spared
- Stinging or burning sensation
- Papules, or small red bumps with no pus, may form around the nostrils
- Pustules, or red bumps with pus in them, may form around the mouth, nose, and occasionally the cheeks
- Dry skin
If left untreated, perioral dermatitis can lead to permanent changes in appearance and become chronic. Using anything that makes the skin drier can also worsen the symptoms. To avoid this, there are some simple treatments available that we’ll discuss.
How do you diagnose perioral dermatitis?
Perioral dermatitis is diagnosed through a thorough examination and testing in order to rule out other possible causes such as rosacea, seborrheic dermatitis which is a condition that causes scaly patches on the face, periorificial herpes simplex infection or cold sores, and steroid-induced perioral dermatitis which is an inflammatory disorder typically associated with long-term use of topical corticosteroids.
There are a couple of key differences that help physicians rule out rosacea. If you have rosacea, you may develop spider veins, whereas perioral dermatitis does not have this symptom. Rosacea is also most common on the nose and cheeks whereas perioral dermatitis is often centered around the nose and mouth, although it does occur on other spots on the body, on rare occasions.
Similarly, physicians can determine it is not acne because of the acute distribution of perioral dermatitis near the mouth and nostrils and not elsewhere on the body. With acne, comedones, or clogged pores that are whiteheads or blackheads, are also present and they do not appear with perioral dermatitis.
Often, doctors are able to determine perioral dermatitis by seeing the affected area and ruling out other possibilities. If the doctor thinks it may be infected, they may also perform a culture test. It is very rare for a doctor to have to take a biopsy of the affected area.
How do you treat perioral dermatitis?
There are several ways to treat perioral dermatitis. As noted above, it is important to avoid using anything that has the potential of making this condition worse for you because your skin can become drier, which will make symptoms more severe. It is therefore advised that you do not use cosmetics or moisturizers on the areas affected by perioral dermatitis unless they have been prescribed to you by a doctor specifically for treating this condition. Often, doctors will first ask patients to stop using topical corticosteroids ointments such as hydrocortisone, fluocinonide, and desoximetasone to determine if this is the cause of the irritation. If this does not clear up your skin, other treatments may be used.
Doctors can also recommend certain topical medications in order to help minimize any further outbreaks and address existing ones. Some options include:
- Oral antibiotics such as tetracycline, minocycline, and doxycycline
- Metronidazole cream applied to the affected area once a day for seven days. This treatment is less effective and you should consult your healthcare provider if you are pregnant, nursing, or if you have liver disease.
If you are given a prescription medication that contains steroids do not apply it directly to your face without first consulting your doctor about any side effects that may occur. It is also important to note that steroid treatment can lead perioral dermatitis into becoming chronic if left untreated after six weeks of use, so try to avoid this method unless absolutely necessary. In some cases, doctors may prescribe a combination of antibiotics and corticosteroids in order to best address the condition, even though corticosteroids are usually avoided during treatment.
There are also several over-the-counter options that can help alleviate perioral dermatitis symptoms such as:
- Brand name moisturizers for gentle skincare like Cetaphil or CeraVe
- Organic moisturizers like aloe vera, shea butter, or cocoa butter
If you are using any medication, lotion, or cosmetics, such as salicylic acid for acne that will dry out your skin, it is recommended to stop using these products while you treat your perioral dermatitis.
Perioral dermatitis can also go away on its own. When the doctor and patient can determine the source of the irritation, such as taking a steroid medication, stopping the use of the irritant can also help clear up your skin from perioral dermatitis.
How do you prevent perioral dermatitis?
The best prevention is eliminating the use of any steroids around your mouth. Besides this simple precaution, there are other steps you can take to avoid perioral dermatitis. Washing your skin daily using gentle cleansers can help keep your skin free of irritants and acne. Using an oil-free sunscreen with an SPF above 30 to protect your skin from the sun is important. Make sure the sunscreen is labeled "oil-free" as some sunscreens with harsher chemicals can exacerbate your symptoms. Light moisturizers can also prevent your skin from drying out and flaking. Be sure all of these products and your cosmetics are non-comedogenic, which means they won't clog pores and are oil-free because they will irritate your sensitive skin more than normal skincare products would.
Perioral dermatitis is an inflammatory skin condition that causes redness and bumps, usually around your mouth or nostrils, although it may occur in other areas as well. It can go away on its own, but sometimes it may be treated with topical medications such as minocycline. There are other over-the-counter moisturizers that can help with dry skin too. If you believe you have symptoms of perioral dermatitis, please see your physician right away. They can usually determine if it is perioral dermatitis without any tests and can prescribe you a treatment plan that is best for you.
References and Sources:
Mount Sinai – Perioral dermatitis
American Osteopathic College of Dermatology – Perioral Dermatitis
Cleveland Clinic – Perioral Dermatitis