How to describe perioral dermatitis

What does the rash look like?

Look for groups of small raised bumps rather than one isolated spot. Some contain pus, and the surrounding skin can have dry, flaky patches. The bumps can appear pink, red or purple, or slightly darker than the surrounding skin. On brown or black skin, redness can be harder to see, and patches can look darker than the person's usual skin colour.3

The rash often affects both sides of the mouth, although it can begin unevenly. It can extend into the folds beside the nose or appear near the outer corners of the eyes. The clear strip beside the lip edge is a useful clue, but it is not always present in severe cases.124

The medical word for a small raised bump is papule. A pustule is a bump containing pus. You can use those terms, but "small bumps, some with pus" describes the appearance just as clearly, which saves the conversation from becoming a vocabulary test.3

How to describe it to a doctor

Describe what you can see and feel rather than deciding the diagnosis first. For example, if it matches your rash: "I have clusters of small bumps around my mouth. The skin is dry and flaky, and it burns. There is a clear strip right next to my lips." Add whether the rash also affects your nose or eyes and whether it keeps returning.123

Mention facial creams, cosmetics and any steroid creams, tablets, inhalers or nasal sprays you use. Steroid exposure is a common association, but the exact cause is not fully understood. A clinician usually diagnoses perioral dermatitis from the rash's appearance and location; tests are not usually needed.13

Does it have to be around the mouth?

Similar outbreaks can occur around the eyes or nose instead of the mouth. Periorificial dermatitis is the broader name for this pattern around facial openings, because the terminology needed an umbrella as well as three addresses. Periorbital means around the eyes, and perinasal means around the nose, which makes a face sound like it needs a directory. Perioral dermatitis is more common in young and middle aged women, but children can develop it too.456

How is it different from acne or a cold sore?

• Acne commonly includes blackheads, whiteheads and sometimes deeper lumps or cysts. Those features are not typical of perioral dermatitis.
• Rosacea commonly affects the central face, including the cheeks and nose, and can include flushing and visible small blood vessels.
• Cold sores are painful sores caused by a virus. Herpes simplex often produces clustered blisters that crust and return to the same location.
• Impetigo can produce golden, honey coloured crusts and spread quickly.

What should you do next?

Arrange a medical assessment for a persistent outbreak, especially if acne treatment is not helping. Perioral dermatitis is treatable, but untreated outbreaks can last months or years. Dermatitis is not contagious.56

Avoid picking or squeezing the bumps. General care involves pausing facial cosmetics and unnecessary creams and washing with water alone while the rash settles. Heavy, occlusive creams and ointments can worsen it. A bland moisturiser can help dryness, and a gel or liquid sunscreen is an option.13

Ask the prescriber how to stop a facial steroid: abruptly stopping a potent steroid can cause a rebound flare. Continue medically necessary inhaled, nasal or oral steroids. Tell the treating clinician if you are pregnant, because treatment choices differ.1

Improvement usually takes several weeks. Treatment can involve prescription creams or oral antibiotics, and an antibiotic course often lasts two to three months. Sensitive facial skin can make topical treatments difficult to tolerate.13