Is perioral dermatitis itchy?

What does perioral dermatitis feel and look like?

The rash usually consists of clusters of small bumps around the mouth, sometimes with scaling or tiny bumps containing fluid or pus. The bumps can look red on lighter skin or skin coloured on darker skin. A narrow strip of skin immediately beside the lips often stays clear. The rash can also develop around the nose or eyes, where the broader name is periorificial dermatitis.134

Burning and sensitivity are common complaints, while pain is rare. Skincare products can aggravate the affected area. Having no itch does not rule out perioral dermatitis: symptoms range from no discomfort to itching and burning.234

Does an itchy rash around the mouth mean perioral dermatitis?

No. Contact dermatitis, a reaction to an irritating substance or allergen, can also cause an itchy facial rash, and its itching is often more intense. Perioral dermatitis can resemble acne, but blackheads and whiteheads are not typical features. A clinician checks the appearance, location and history of the rash rather than diagnosing it from itching alone. Usually, an examination is enough; a biopsy is occasionally needed when the diagnosis is unclear.2567

What should you change in your skincare routine?

A pared back routine can help mild cases settle. The first useful change is often removing products rather than adding them, which gives the skincare shopping list a rare day off.2

1. 1Pause makeup and other facial cosmetics, and reduce unnecessary topical products.
2. 2Wash gently. Warm water alone is an option while the rash is active; if you need a cleanser, choose a mild, fragrance free one rather than scrubbing.
3. 3For dryness, use a bland moisturiser without unnecessary additives if needed. Avoid thick, occlusive creams and ointments, which can worsen perioral dermatitis.
4. 4If you need sunscreen, a gel or liquid formula is an option. Identify suspected product triggers with your clinician rather than adding more products to counteract irritation.

A mild cleanser can be enough for washing, without assembling a supporting cast from the rest of the bathroom.4

Should you use hydrocortisone for the itch?

Do not start hydrocortisone to treat suspected perioral dermatitis. Facial steroid creams can briefly improve the rash but worsen it over time. If you are already using a prescription steroid, contact the prescriber before changing it: stopping suddenly can cause a rebound flare, and a supervised taper is sometimes needed. Do not restart a steroid just because the rash flares after stopping. Medically necessary inhaled, nasal or oral steroids should continue; rinsing the face and mouth after inhaled or nasal steroids can help.1234

When should you see a doctor?

Arrange an assessment if the diagnosis is uncertain or the rash is not clearing after routine changes. More than one skin condition can occur at once, and treatment for one need not help another. If you develop pink eye alongside the rash, tell your clinician; an eye assessment can be needed.157

Treatment can include topical metronidazole or erythromycin, or an oral antibiotic when topical treatment is insufficient. Antibiotics are used for their anti inflammatory effect as well as other actions. Pregnancy changes medication choices, so tell the prescriber if you are pregnant; erythromycin is an option used during pregnancy.467

How long does it take to settle?

Expect gradual improvement over weeks rather than overnight clearing. Complete clearance can take a few weeks to a few months. Treatment commonly lasts four to eight weeks and sometimes longer. Without treatment, the rash can persist for months or years, and it can return after successful treatment.123