How to help perioral dermatitis

First, make sure you are treating the right rash

Perioral dermatitis causes small bumps around the mouth, often with dry, flaky skin. The bumps can look red on light skin or skin coloured on darker skin, and can itch or burn. The same condition around the nose or eyes is called periorificial dermatitis. It is not contagious.1

Acne, rosacea and other forms of dermatitis can look similar. A clinician can usually diagnose perioral dermatitis by examining your skin. Treatments for one skin condition do not necessarily help another, so do not assume every cluster of facial bumps needs acne treatment.345

What to do now

1. 1Check your steroid creams. Stop hydrocortisone you started without your doctor's knowledge. For prescribed creams, contact the prescriber about stopping or gradually reducing treatment, especially after prolonged use.
2. 2Pause facial cosmetics and unnecessary skincare. Wash gently with warm water alone while the rash is active. If you need a cleanser, choose a mild, fragrance free option.
3. 3Avoid heavy creams and ointments that seal in moisture, including petroleum based products. For troublesome dryness, a bland moisturizer without additives can be used.
4. 4Review sunscreen texture. A gel or liquid sunscreen is an option instead of a heavy cream.
5. 5Keep medically necessary nasal, inhaled or oral steroids unless your prescriber changes them. Rinse your face and mouth after using nasal or inhaled steroids.

Makeup and cosmetic creams belong on the pause list, even if their packaging has already promised to solve everything. The temporary routine can be warm water alone, which gives the bathroom shelf an unusually small job.2

Why steroid cream can make things worse

Steroid cream can give temporary relief, but the rash can flare when you stop it. Restarting the cream repeats that cycle. Do not restart it on your own to settle a flare. A clinician can sometimes use a weaker steroid briefly alongside other treatment as part of a withdrawal plan.12

What treatment can a doctor offer?

Mild cases can clear with fewer products alone. Other cases need prescription treatment applied to the skin, such as metronidazole, erythromycin or pimecrolimus. Sensitive facial skin can struggle to tolerate topical treatment, so report irritation rather than adding more products to compensate.5

For more severe cases, a doctor can prescribe an oral antibiotic such as doxycycline or erythromycin. These medicines help reduce inflammation; being prescribed an antibiotic does not mean the cause of the rash is a confirmed bacterial infection. Pregnancy and a child's age affect the choice: erythromycin is an option for pregnant patients and children under eight. Follow the prescribed schedule rather than choosing your own dose or duration.235

How long does improvement take?

Expect gradual improvement over a few weeks to a few months. Treatment sometimes lasts six to twelve weeks, and some people need several months. The bumps can return, particularly after steroid creams are used again. If the rash returns after successful treatment, contact your clinician; the treatment that helped before can often be used again.123

When to get medical help

Book an appointment for bumps around your mouth that do not go away, or a rash that persists after stopping self directed steroid use. Bring details of your skincare, toothpaste and steroid medicines to help identify possible triggers. No food or drink is known to cause or worsen perioral dermatitis, so a restrictive diet is not an established treatment. Contact your healthcare provider if you also develop pink eye. Seek urgent medical advice for blurred vision or severe burning, peeling or oozing sores after hydrocortisone use.1236