How to treat perioral dermatitis

What does perioral dermatitis look like?

Perioral dermatitis causes clusters of small bumps around the mouth, sometimes with redness, scaling or tiny pustules. The skin can itch or burn, although some people have no discomfort. A narrow strip immediately beside the lips often stays clear. Unlike acne, perioral dermatitis does not produce blackheads, whiteheads, deep nodules or cysts. Similar eruptions can appear around the nose or eyes; the broader name is periorificial dermatitis. These clues help distinguish the rash, but they are not a diagnosis.34

What should I do first?

1. 1Arrange an assessment with a doctor or dermatologist, particularly if you have been treating the bumps as acne without improvement.
2. 2Check whether you have used a steroid cream on your face, including hydrocortisone. Tell your clinician the product name and how long you have used it before changing a prescribed treatment.
3. 3Remove unnecessary cosmetic products from the affected area, especially thick facial creams and oily products.
4. 4Wash your face twice daily, morning and evening, with water and a mild soap or a non soap, non cream cleanser.
5. 5Discuss prescription treatment rather than adding more acne products. The right treatment depends on the diagnosis, severity and whether steroids have contributed.

For mouth area dermatitis, water based makeup and sunscreen are preferable to oily facial products, although cosmetics themselves can be triggers. Removing unnecessary cosmetics is part of treatment, which is an unusually poor business model for the skincare aisle.13

Why does steroid cream help, then make it worse?

Facial steroids can make perioral dermatitis look better briefly, then leave the bumps more widespread and inflamed. A flare after withdrawal can encourage another application, creating a cycle of temporary improvement and deterioration. Hydrocortisone is usually classed as a mild steroid, but that does not make it a suitable self treatment for perioral dermatitis. If you have used a prescribed steroid for a long time, do not stop it without advice. A clinician can decide whether to reduce its strength or frequency before stopping.1236

Which medicines treat perioral dermatitis?

Treatment takes weeks, not days. Oral antibiotic courses commonly last 4 to 8 weeks, with courses of 6 to 12 weeks also used. Longstanding disease can need longer treatment. Those are course lengths, not deadlines for visible improvement. Do not judge the treatment by the brief improvement a steroid cream produced.13

What changes during pregnancy or for children?

Pregnancy and childhood change the medicine choices. Tetracycline antibiotics are not the usual option during pregnancy or for young children. A clinician can consider topical treatment or an alternative antibiotic. Erythromycin is an option during pregnancy when treatment is essential, and macrolide antibiotics such as erythromycin are used for younger children with dermatitis around the eyes. Tell the prescriber if you are pregnant before treatment is selected.136

What if the rash is around my eyes?

Dermatitis confined to the skin around the eyes is called periocular dermatitis. Initial management involves stopping creams, moisturizers, sunscreen and makeup on that area, with a supervised withdrawal plan for any facial steroid. Mild cases can be treated with topical medicines; moderate or severe cases can need oral antibiotics, sometimes for up to three months. Other prescription options include pimecrolimus or tacrolimus. Isotretinoin is generally reserved for resistant cases. Clearing can take weeks or months.6

What causes it, and should I change toothpaste?

The exact cause is often unknown. Facial steroids, thick cosmetics and hormonal changes can contribute. Dental products, including fluoride containing toothpaste and tartar control products, are possible triggers rather than universal causes. Discuss a suspected dental product trigger instead of assuming everyone needs to change toothpaste. Inhaled and nasal steroids are also relevant to your medication history. Makeup, sunscreen and moisturizer can all belong on the trigger list, so a cosmetic product does not get a free pass for looking helpful on the bathroom shelf.1367

When should I see a doctor?

See a doctor if the diagnosis is uncertain, the rash persists, or acne treatment has not helped. Perioral dermatitis can resemble acne or rosacea, and treatments for one condition do not necessarily treat another. Diagnosis usually comes from examining the rash and reviewing your history. Testing is not usually needed, but a rash that does not respond to appropriate treatment warrants reassessment. Dermatitis is not contagious and does not mean your skin is dirty or infected.157

If you use hydrocortisone, tell a pharmacist or doctor about side effects that bother you or do not go away. Seek urgent medical advice for suspected serious effects, including blurred vision. Throat or tongue swelling and difficulty breathing can signal a serious allergic reaction and need emergency help. After steroid withdrawal, marked burning, intense itching, peeling or oozing sores also need medical assessment rather than being assumed to be an ordinary dermatitis flare.2

Can perioral dermatitis be cured?

Perioral dermatitis can clear with appropriate treatment, but recurrence is possible. Completing an adequate treatment course matters because recurrence is more common when oral treatment is too short. Untreated dermatitis can fluctuate for months or years, so waiting indefinitely is not a reliable treatment plan. For dermatitis around the eyes, avoiding potent facial steroids and thick creams helps prevent recurrence. If the rash returns, have the diagnosis, medicine history and cosmetic routine reviewed rather than restarting a steroid cream.146