What is perioral dermatitis?

Perioral dermatitis is a common skin condition which causes a rash of inflamed bumps around your mouth. They usually appear red, but on darker skin, they can appear hyperpigmented or brown. It can make your skin scaly, dry, and flaky, and cause itching or burning. It is sometimes confused with acne.

The condition is often caused by either topical steroid use or overuse of skin products. Perioral means ‘around the mouth’, and dermatitis means inflammation of the skin. Although perioral dermatitis starts around the mouth, it can sometimes spread to the nose, eyes, and in rare cases, the genitals. It can affect both children and adults of any age, but it is most common in women between 20 and 45 years old.

What are the symptoms of perioral dermatitis?

Normally, perioral dermatitis starts when bumpy spots known as papules develop on the skin around your mouth. It can look like acne, and sometimes the papules have pus inside them. The surrounding skin is often red or pink, or a similar colour to the papules themselves.

The surface of your skin can become dry and flaky. Often, the skin right next to your lips is not affected. It is not always painful, but can cause mild itching or burning sensations.

Symptoms can also develop around your eyes and nose, and rarely it can occur on your genitals. If it occurs on your eyelids it is known as periocular dermatitis. Some people get conjunctivitis when they have periocular dermatitis. In even rarer cases it can also occur on your ears, neck, scalp, and other parts of your body.

Perioral dermatitis can last for several weeks, or even months. It is often a condition which will reoccur until you find out what is causing it.

Complications and long-lasting effects of perioral dermatitis

If you do not get treatment for perioral dermatitis, it may not go away. If it becomes severe, you can be left with scars.

Perioral dermatitis can return after treatment, even if it was successful. Sometimes it can look like rosacea, a similar skin condition which causes papules in the middle of your face around your nose. Rosacea is a recurring inflammation which can cause flushing and acne symptoms.

When should I talk to my GP about perioral dermatitis?

If you have the symptoms of perioral dermatitis, you should talk to your GP about it. Sometimes it can look similar to other conditions so it’s important that you get a proper diagnosis and the right treatment.

What causes perioral dermatitis?

Perioral dermatitis can be caused by a variety of factors. They include:

• topical steroid creams
• inhaled prescription steroid sprays
• long term or overuse of steroids
• moisturisers and face creams, especially if they contain paraffin or petroleum jelly
• makeup, especially foundation
• overuse of skin products like facial scrubs
• toothpaste containing fluoride or tartar control ingredients
• SLS, a compound found in some cleansers and shampoos
• high SPF sun cream, particularly for children
• UV light
• chewing gum
• dental fillings
• hormonal changes, including those caused by oral contraceptives
• dysfunction of the epidermal barrier, the outermost layer of your skin
• immune system problems
• changes or imbalance in your skin’s bacteria
• an allergic reaction

Perioral dermatitis is not contagious.

In children, lip licking and chewing, thumb sucking, and drooling can also cause perioral dermatitis.

Research has also suggested that heat and wind can contribute to symptoms of perioral dermatitis.

What increases your risk of Perioral Dermatitis?

Some people are more likely to get perioral dermatitis. Risk factors include:

• sex assigned at birth, as it is more common in women
• age, as it is more common in young and middle-aged adults
• use of topical steroids
• problems with hormonal imbalance
• history of allergies
• overuse of skin products, cosmetics, and makeup

Although it can affect both children and adults, it is most common in women between 20 and 45 years old.

How is perioral dermatitis diagnosed?

Perioral dermatitis can be diagnosed online with Superdrug Online Doctor, by simplifying uploading some photos of your skin. Our doctors can then diagnose your skin condition, and give you advice on next steps and offer treatment where possible. It can also be diagnosed by your GP with a simple visual examination of the skin and by asking you some questions about your symptoms.

These include:

• rosacea
• acne vulgaris
• contact dermatitis
• eczema

Having a skin biopsy or seeing a dermatologist is often not necessary unless you have ongoing or worsening symptoms after treatment or if your doctor thinks you have an infection.

How is perioral dermatitis treated?

Perioral dermatitis can be treated by stopping the use of creams, ointments, cosmetics, steroid sprays, topical steroids, face scrubs, or any other products you use on your face or affected areas. Always check with your GP before stopping any prescription medications. With topical steroids, stopping using them can sometimes make the rash worse for a few days. When you have symptoms, you should wash your face with warm water only. Your GP may also advise you to stop using toothpaste with fluoride in it.

If the rash is mild, you may be prescribed topical or oral antibiotics or pimecrolimus cream to help reduce the inflammation. These can take up to two months to work, so it is important to continue with the course you were given unless your doctor advises you otherwise.

Washing your pillowcases and towels frequently in hot water can sometimes help to reduce symptoms. Salty and spicy foods can irritate the skin around your mouth, so limiting them can also help.

Can perioral dermatitis be cured?

There is no permanent cure for perioral dermatitis, but it can resolve with treatment. Without treatment, perioral dermatitis can last for months or years. Equally, it can also go away on its own.

Sometimes the rash can reoccur. To reduce the risk of this, use a mild, fragrance free cleanser to wash your face and try to eliminate or minimise the use of skin products on your face. If your symptoms flare up again, the same treatments that worked the last time are likely to help.

How do the treatments work?

Antibiotics

It is not clear how antibiotics work against perioral dermatitis, as it is not an infection. However, some antibiotics do work to reduce inflammation as well as kill bacteria, such as tetracyclines, so that may explain why they can sometimes be helpful for perioral dermatitis. They are not effective for everyone, though. Antibiotic treatments can take up to two months to start working, although some people see an improvement within a few weeks. A common antibiotic used to treat perioral dermatitis is Metronidazole.

Azelaic Acid

Topical creams or gels containing azelaic acid, such as Finacea Gel, are sometimes used to treat perioral dermatitis. While these treatments do not cure perioral dermatitis, they can reduce the inflammation caused by the condition and help to manage the symptoms. 

How to treat perioral dermatitis naturally

Natural solutions to treat perioral dermatitis include:

• avoiding using topical steroids, cosmetics, and other products in affected areas
• washing affected areas with warm water only
• staying out of the sun
• using a toothpaste without fluoride

It has also been suggested by a study that coconut oil can help some people who get perioral dermatitis. However, others may find it clogs their skin pores and makes it worse.

How to prevent perioral dermatitis

There is no medicine or particular course of action that can guarantee the prevention of perioral dermatitis. The risk factors for symptoms can vary between people, and researchers are still working to understand the causes of it.

However, you can help to prevent perioral dermatitis by:

• avoiding topical steroids and steroid creams, but consult your GP or dermatologist before you do this
• reducing or eliminating the use of creams, cosmetics and skin care products on your face
• reducing time in direct sunlight, hot weather, and windy conditions

It is not currently known if diet is related to flare ups of perioral dermatitis. There are no known foods that can improve or worsen symptoms.

Speak to your GP or dermatologist about recommendations for skin products.

Sources

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Perioral Dermatitis Cleveland Clinic [accessed 12th August 2022]

Contact Dermatitis NHS [accessed 11th August 2022]

An Itchy Rash Around the Lips Very Well Health [accessed 11th August 2022]

Perioral Dermatitis Healthline [accessed 11th August 2022]

What is perioral dermatitis and how is it treated? Medical News Today [accessed 11th August 2022]

Perioral Dermatitis Rademaker (2019), Wiley Online Library [accessed 11th August 2022]

Perioral Dermatitis Tolaymat & Hall (2022), National Library of Medicine [accessed 12th August 2022]

Anti-Inflammatory and Skin Barrier Repair Effects of Topical Application of Some Plant Oils Lin et al (2018), National Library of Medicine [accessed 12th August 2022]

Perioral Dermatitis Ting & Barankin (2007), National Library of Medicine [accessed 12th August 2022]