Perioral dermatitis information for patients

What does perioral dermatitis look and feel like?

Typical signs are clusters of small raised bumps, sometimes containing pus, with redness and flaking. The skin directly beside the lip usually stays clear. Burning, sensitivity and itching can occur. When the rash also surrounds the eyes or nose, the broader name is periorificial dermatitis.1

A rash around the mouth is not automatically perioral dermatitis. Eczema can extend right up to the lips and can be intensely itchy. Acne commonly includes blackheads or whiteheads as well as inflamed spots. Perioral dermatitis often leaves a clear strip beside the lips and has grouped bumps on flaky patches. Redness can be less obvious on darker skin, so the colour alone is not enough to identify a facial rash.2

What causes it?

The exact cause is unknown. Facial steroid use has a strong association with perioral dermatitis. Possible triggers also include cosmetics, sunscreen, fluoride toothpaste, and inhaled or nasal steroids. These are possible contributors, not a reason to stop every product or medicine. The condition most commonly affects young adult women, but men and children can develop it too.1

Should I use hydrocortisone on the rash?

Do not start hydrocortisone to treat suspected perioral dermatitis without medical advice. Hydrocortisone is a steroid medicine, and perioral dermatitis is among the conditions that can make it unsuitable. Speak to a pharmacist or doctor before using hydrocortisone anywhere on the face. Calling a steroid "mild" does not make it suitable for this rash.3

Facial steroids can initially suppress the rash, then allow it to flare when withdrawn. Repeated use can worsen the condition. A clinician can plan withdrawal, including a gradual reduction when necessary. If you have been prescribed hydrocortisone for prolonged use, do not stop it suddenly without advice from your doctor or pharmacist.13

Where can I find perioral dermatitis patient information in the UK?

The British Association of Dermatologists website has a Patient Information Leaflets section and a Patient Hub. Its leaflets explain skin conditions, causes, treatments and practical care. The Patient Hub also covers using NHS services and finding a dermatologist. For questions specifically about hydrocortisone and perioral dermatitis, the NHS hydrocortisone for skin page includes suitability advice.34

How is perioral dermatitis treated?

Prescription options include metronidazole applied to the skin, topical calcineurin inhibitors, which are medicines that reduce inflammation, and oral tetracycline antibiotics. A clinician usually diagnoses the rash by examining it. An unusual appearance or failure to respond to treatment can warrant a biopsy, meaning a small skin sample, or other tests.1

At your appointment, mention facial creams, steroid medicines, toothpaste and any skincare products that seem to aggravate the rash.1

Will it clear, and can it return?

Treatment is generally effective, but perioral dermatitis can persist or return. Ongoing management is sometimes needed. A flare during steroid withdrawal needs a treatment review rather than repeated, unsupervised steroid use.1

What if I am pregnant or breastfeeding?

If you are pregnant, check with a pharmacist or doctor before using hydrocortisone on your skin. Hydrocortisone can usually be used while breastfeeding, but check first. Suitability during pregnancy or breastfeeding does not override the separate concern about using hydrocortisone for perioral dermatitis.3

When should I seek medical advice?

Ask for an assessment if the diagnosis is uncertain or the rash is not responding to treatment. If you use hydrocortisone, speak to a pharmacist or doctor about side effects that bother you or do not go away. In the UK, call NHS 111 if you are using, or have recently used, hydrocortisone and suspect serious side effects, including blurred vision or marked worsening with burning, peeling or oozing sores.13

Where else can I find patient information?

MedlinePlus lists a perioral dermatitis patient handout in its Medical Encyclopedia, with a Spanish version also available. Look under Patient Handouts on its Mouth Disorders page, where even a leaflet has a filing address.5

The American Academy of Dermatology lists a Perioral Dermatitis Pamphlet in its patient handout collection, which is a formal introduction for something meant to be handed out. It covers who develops the condition, causes, treatment options and preventing recurrence. The pamphlet is sold in packs of 50, which is a waiting room quantity rather than a personal reading assignment.67