Does perioral dermatitis itch?

What else does perioral dermatitis feel and look like?

The rash usually forms clusters of small bumps around the mouth. Bumps can look red on lighter skin or skin coloured on darker skin, and the surrounding skin is often dry, flaky or scaly. Some bumps contain pus. A narrow strip immediately next to the lips is usually spared. Skin sensitivity is common, while pain is rare.234

The rash can also appear around the nose or eyes, either alongside the mouth rash or on its own. The longer name is periorificial dermatitis when other facial openings are involved, because even a rash can acquire a longer job title. Perioral dermatitis is not contagious.235

Does an itchy mouth rash mean perioral dermatitis?

Itch alone cannot identify the rash. Allergic or irritant contact dermatitis can look similar and often causes more intense itching. Acne and rosacea are other possible lookalikes. Blackheads, deeper nodules and cysts are not typical of perioral dermatitis. A clinician checks the appearance, location and history of the rash rather than using itch as a diagnostic test.14

What can you do about the irritation?

Skincare products can aggravate affected skin. Reducing cosmetics is part of managing perioral dermatitis, so the bathroom shelf does not need to submit another candidate. Wash gently rather than scrubbing. A mild cleanser without fragrance is one option; washing with warm water alone while the rash is active is another. Avoid heavy, occlusive creams and ointments that seal over the skin, as they can worsen the rash. For dryness, a bland moisturiser without additives is an option, and sunscreen can be a gel or liquid.1234

Should you use hydrocortisone for the itch?

Do not start hydrocortisone to soothe suspected perioral dermatitis. Facial steroid creams can temporarily improve the rash but worsen the condition over time. If you are using hydrocortisone without a doctor's advice, stop using it. If the steroid is prescribed, contact the prescriber before changing it: stronger creams sometimes need a gradual withdrawal plan. Tell a doctor or pharmacist about perioral dermatitis before using betamethasone skin treatment.236

The rash can flare after stopping a steroid. Restarting the cream for temporary relief can repeat the cycle, so ask the prescriber how to manage withdrawal instead. Continue medically necessary inhaled, nasal or oral steroids. Rinsing your face and mouth after inhaled or nasal steroids can help.24

When should you see a doctor, and how long does clearing take?

Arrange an assessment if you are unsure what the rash is or it is not clearing. A dermatologist can distinguish perioral dermatitis from acne and other conditions, then choose treatment. Options include topical metronidazole, other prescription creams and oral antibiotics. Sensitive facial skin can make topical treatments difficult to tolerate. Tell the prescriber if you are pregnant or treatment is for a child, because antibiotic choices differ.345

Expect gradual improvement over weeks rather than an immediate fix. Complete clearing can take a few weeks to a few months. Some antibiotic courses last 6 to 12 weeks, depending on the treatment plan. Without treatment, the rash can fluctuate for months or years, and recurrence after treatment is possible. If appropriate treatment is not helping, the clinician can reconsider the diagnosis and whether further testing is needed.12