Can perioral dermatitis be cured?

Make sure you are treating the right rash

Perioral dermatitis causes small bumps, redness and sometimes pus filled spots around the mouth. The skin can feel sore or burning and look dry or flaky. Bumps can appear pink, red or purple, or slightly darker than the surrounding skin. Similar eruptions around the nose or eyes are called periorificial dermatitis.12

Have a healthcare professional assess an unexplained facial rash before choosing a treatment. Perioral dermatitis can resemble acne or rosacea, and treatments for one skin condition do not necessarily work for another. A clinician usually diagnoses perioral dermatitis by examining the rash and where it appears, rather than ordering routine tests.13

What should you do first?

1. 1Review any facial steroid cream with your doctor or pharmacist. Steroid creams need to be withdrawn, but prolonged or potent steroid use can require a gradual reduction rather than an abrupt stop.
2. 2Set aside facial cosmetics and unnecessary topical products unless your clinician advises otherwise. During treatment, cosmetics can stay off the face, regardless of how enthusiastically their packaging describes the benefits.
3. 3Wash with warm water alone until the rash clears. Do not pick or squeeze the bumps.
4. 4If dryness needs relief, discuss a bland moisturiser without added fragrance. Avoid thick, occlusive creams and ointments that can worsen perioral dermatitis. A gel or liquid sunscreen is an option.

Do not start hydrocortisone as a home treatment for this rash. Hydrocortisone is unsuitable for perioral dermatitis, and facial use needs advice from a pharmacist or doctor. If you already use prescribed hydrocortisone long term, get advice before stopping. Continue medically necessary inhaled, nasal or oral steroids; rinsing your face and mouth after nasal or inhaled steroids can help.24

Which treatments clear it?

Mild cases can settle after withdrawing triggering products. Prescription topical options include metronidazole, erythromycin and pimecrolimus. Sensitive facial skin sometimes cannot tolerate topical treatments. More substantial disease often needs an oral antibiotic such as doxycycline or lymecycline. Tetracycline antibiotics are used chiefly for their effects on inflammation, not simply to kill bacteria. Pregnancy and age change the choice: erythromycin is an oral option for pregnant women and children under eight.125

How long does clearing take?

The rash usually clears within several weeks, but an antibiotic course commonly lasts two to three months and sometimes longer. Follow the prescribed course rather than stopping as soon as the skin looks better. A flare can occur when facial steroids are withdrawn; do not restart them to suppress it. Contact your clinician if treatment is irritating or the rash is not improving.12

What if the usual treatment fails?

Persistent disease deserves a dermatology review, not an endless repeat of an ineffective prescription. Specialist options include isotretinoin for selected resistant cases, although support for its use is limited. One woman with persistent disease improved markedly after three months of isotretinoin and reached near complete resolution after six months. JAK inhibitors, medicines that alter immune signalling, have also cleared resistant cases, but have caused similar eruptions in others. They are not routine first treatments.256

Can it come back after treatment?

Yes, recurrence can happen after antibiotics finish or later. The same treatment can often be used again under medical supervision. After clearing, use a soap substitute to cleanse and an unperfumed moisturiser if your skin is dry or sensitive. Returning to skincare does not require reinstating every bottle, even if the bathroom shelf considers that a demotion.12