Does perioral dermatitis burn?

What does the burning feel like?

The affected skin can feel sensitive, tight and irritated. Burning is a recognised symptom, but pain is uncommon. The rash usually includes clusters of small bumps with dry or scaly skin around them. A narrow strip of skin immediately beside the lips often stays clear. The bumps can look red on lighter skin or skin coloured on darker skin, and the rash can also develop around the nose or eyes.12

Does burning mean it is perioral dermatitis?

No. Burning alone cannot identify the cause. Perioral dermatitis can resemble acne, rosacea or contact dermatitis, which is inflammation caused by an irritant or allergy. Unlike acne, perioral dermatitis typically lacks blackheads and whiteheads. A clinician usually diagnoses it by examining the skin; patch testing for contact allergy or other tests can help when the diagnosis is uncertain. A persistent breakout around the mouth deserves a diagnosis rather than another round of acne treatment.134

What should you do when the skin burns?

Reducing facial products is part of treatment and can clear mild cases. Facial cosmetics can stay on the shelf during this pared back routine, even if the packaging has promoted them to necessities. Oily cosmetics and some moisturizers can worsen the rash, so the word "nourishing" does not earn a product an automatic place in the routine.13

1. 1Review what touches the affected skin, including cosmetics, skincare and steroid creams. Set aside facial cosmetics and unnecessary topical products.
2. 2Wash gently with warm water alone while the rash clears. If using a cleanser, choose a mild, fragrance free one rather than scrubbing.
3. 3If dryness needs treatment, a bland moisturizer without additives is an option. Avoid heavy, occlusive creams and ointments that form a sealing layer over the skin.
4. 4If you need sunscreen, a gel or liquid formula is an option. Follow any prescribed treatment directions rather than adding extra products to address the burning.

Do not self treat the burning with hydrocortisone. Stop nonprescription hydrocortisone being used without your doctor's advice, but contact the prescriber before changing a prescription steroid. Withdrawal can temporarily worsen the rash, and restarting the cream can create repeated flares. A clinician can plan withdrawal from a strong facial steroid. Continue medically necessary inhaled, nasal or oral steroids; rinsing the face and mouth after inhaled or nasal steroids can help.12

Could toothpaste be involved?

Toothpaste can irritate skin around the mouth or cause contact allergy, although allergic reactions are rare. Flavourings are the main toothpaste allergens, and sodium lauryl sulphate can cause irritation around the mouth. Burning inside the mouth, especially with redness, swelling or peeling of the gums, tongue or inner cheeks, can occur with contact stomatitis, meaning inflammation inside the mouth. That is a different presentation from a rash on the surrounding skin. A clinician can investigate suspected allergy and help identify an alternative product.5

When should you see a doctor?

Arrange an assessment if the rash persists, the diagnosis is unclear or pain is prominent. If your eyes become red or inflamed, contact a healthcare provider; an eye assessment can be needed. Treatment can include prescription creams or gels, or oral antibiotics that help reduce inflammation. Tell the prescriber if you are pregnant, because antibiotic choices differ. Sensitive facial skin does not always tolerate topical treatments, so report worsening irritation to the prescriber.16

Expect gradual improvement rather than immediate relief. Complete clearing can take a few weeks to a few months, and untreated perioral dermatitis can last months or years. The rash can return after successful treatment; a clinician can review whether the previous treatment is suitable again.246