How to reduce perioral dermatitis

Make sure you are treating the right rash

Perioral dermatitis usually causes small bumps and dry, flaky skin around the mouth. The bumps can look red on lighter skin or skin colored on darker skin. Burning and itching are possible, but neither is required. The same condition can affect the skin around the nose or eyes, where it is also called periorificial dermatitis. It is not contagious.13

Acne, rosacea and other forms of dermatitis can look similar. Blackheads and whiteheads point toward acne rather than perioral dermatitis. A clinician can usually diagnose the rash by examining it; an unusual appearance or failure to respond to treatment can call for further testing. Treatments for different kinds of dermatitis are not interchangeable.2345

What to change first

1. 1Review steroid use first. Stop hydrocortisone you started without your doctor's knowledge. For prescribed facial steroids, contact the prescriber before changing treatment. Stopping suddenly can cause a rebound flare, and a supervised gradual reduction is sometimes needed.
2. 2Remove unnecessary facial products. Mild cases can settle with an approach called zero therapy, which means stopping topical products rather than adding treatments. Review makeup, moisturizers and heavy face creams as possible contributors.
3. 3Make cleansing gentle. If you need a cleanser, switch to a mild, fragrance free one and wash gently. Choose fragrance free skincare rather than continuing products that aggravate the rash.
4. 4Arrange an examination if the rash persists. Bring a list of skincare and medicines, including nasal sprays and inhalers, so your clinician can review possible triggers and choose treatment.

Reducing the number of facial products is a treatment approach, not a vacancy notice for replacement products.2

What if stopping steroid cream makes it worse?

The rash can flare when you stop a topical steroid. Restarting it on your own can give temporary relief while keeping the cycle going. Do not resume it unless your clinician tells you to. Some treatment plans use a milder steroid briefly alongside another medicine, but that is a supervised exception, not a reason to keep treating the rash with hydrocortisone.16

Do you need to change toothpaste or sunscreen?

The exact cause is unknown. Toothpaste containing fluoride, cosmetics, sunscreens, heavy creams and chewing gum have been linked to some cases, but these are possible triggers rather than a universal explanation. Review suspected products with your clinician instead of changing everything indiscriminately. Nasal and inhaled steroids also belong in that discussion; do not stop prescribed medicine without checking with the prescriber. No food or drink is known to cause or worsen perioral dermatitis.146

Makeup and face creams belong on the product review list, even when the packaging would prefer to discuss radiance.6

What treatment can a doctor offer?

Prescription options include medicines applied to the skin, such as metronidazole or pimecrolimus, and oral antibiotics such as doxycycline or tetracycline. Oral antibiotics help reduce inflammation and are used for more substantial cases, sometimes alongside a topical medicine. Pregnancy and age affect the choice: oral erythromycin is an option clinicians use for pregnant patients and preadolescents. The medicine and application schedule should come from your treatment plan.46

How long does improvement take?

Expect gradual improvement rather than overnight clearance. The rash can take a few weeks or a few months to clear completely, and it can return after successful treatment. See a dermatologist if it does not disappear after addressing topical steroids or remains difficult to control. If you develop pink eye alongside the rash, contact your healthcare provider; an eye specialist assessment can be needed.16