Perioral dermatitis treatment at home

Does the rash look like perioral dermatitis?

Perioral dermatitis usually causes clusters of small bumps around the mouth, sometimes extending around the nose or eyes. The bumps can look red on lighter skin or skin coloured on darker skin. Dryness, flaking, itching and burning are common, although some people have no itching or burning. A narrow strip of skin immediately beside the lips often stays clear.13

Unlike acne, perioral dermatitis does not usually produce comedones, meaning blackheads and whiteheads, or deep nodules and cysts. Appearance alone is not enough to diagnose yourself: contact dermatitis and other facial rashes can look similar. A clinician usually diagnoses perioral dermatitis by examining the skin and asking about your history; a biopsy is rarely necessary.34

How to care for the rash at home

Start by removing possible triggers rather than adding more treatments. Pausing makeup and face creams is part of home care, which gives the bathroom shelf a rare chance to do nothing.5

1. 1Pause facial cosmetics and nonessential skincare, including face creams. A stripped back routine can be enough for mild cases.
2. 2Wash with warm water alone while the rash is active. Once the rash clears, consider a nonsoap liquid cleanser.
3. 3If you need a cleanser during treatment, choose a mild, fragrance free option and wash very gently. Mild cleansing twice daily is another approach; scrubbing is not part of it.
4. 4Keep prescription treatment separate from the products you are pausing. Follow the prescribed directions rather than stopping every cream indiscriminately.

Can you use moisturiser and sunscreen?

Thick, oily creams and ointments that form a heavy covering over the skin can worsen perioral dermatitis. A rich face cream is not automatically the right answer to dryness here, despite the impressive amount of comfort promised by the jar. If dryness needs relief, a plain moisturiser without added ingredients or preservatives is an option, rather than a heavy ointment. Start with fewer products, not several replacements.6

Sunscreens can be associated with the rash, but a gel or liquid sunscreen is an option during treatment. Water based sunscreen is preferable to an oily facial cream. Sunlight, heat and wind can also worsen perioral dermatitis, so stopping a troublesome sunscreen does not mean sunlight becomes a treatment.36

Why hydrocortisone can make it worse

Steroid creams can briefly make the rash look better, then leave more inflamed and widespread bumps. Stop hydrocortisone that you have been applying without your doctor's knowledge. If a steroid was prescribed, ask the prescriber how to change treatment. Strong steroids sometimes need gradual withdrawal using a weaker product, rather than an abrupt stop.123

The rash can flare after a steroid cream is stopped. Restarting the cream for temporary relief can lead to another flare when you stop again. Do not restart it yourself; a clinician can decide whether a supervised withdrawal plan or another medicine is needed.15

Medically necessary inhaled, nasal and oral steroids should continue. Rinsing your face and mouth after a nasal spray or inhaled steroid can help reduce contact with the medicine. These medicines can lengthen recovery, but that is a reason to discuss the rash with your prescriber, not to stop necessary treatment yourself.6

What about toothpaste, food and home remedies?

The exact cause is unknown. Steroid exposure, heavy moisturisers, cosmetics and fluoridated toothpaste are recognised associations, but they are not a checklist of things that caused every case. If the rash persists, include toothpaste and other dental products in the trigger discussion with your clinician; avoiding fluoridated dental products is one treatment approach.257

No food or drink is known to cause or worsen perioral dermatitis, so a restrictive diet is not an established treatment. Chewing gum has been linked to some cases. Bacteria and yeast have been proposed as explanations, but the cause remains uncertain. Perioral dermatitis is not contagious, and a rash around the mouth does not by itself establish a fungal infection.15

What treatment can a doctor prescribe?

Prescription options include metronidazole, erythromycin and pimecrolimus applied to the skin. Metronidazole 0.75% gel or cream and erythromycin 2% are examples used twice daily. The right medicine and formulation depend on your treatment plan. Sensitive facial skin can make topical treatment difficult to tolerate; report irritation rather than increasing applications.467

Azelaic acid can help some mild cases, but it is not a reason to start several acne treatments on a rash that only resembles acne. Topical treatment is not always enough. If the rash does not respond, a clinician can change the approach rather than simply adding more products.34

More severe cases can need antibiotic tablets, including doxycycline, minocycline, tetracycline or erythromycin. Antibiotics help control inflammation and sometimes accompany topical treatment. Tell the prescriber if you are pregnant or the treatment is for a child: erythromycin is an option used in pregnancy and younger children. Do not choose an antibiotic or dose yourself.25

How long does recovery take?

Expect gradual improvement over weeks, with complete clearing sometimes taking a few months. Medication courses commonly last 4 to 8 weeks, and some people need 6 to 12 weeks or longer. Follow the planned course rather than treating the first improvement as the finish. The rash can return, particularly if steroid creams are used again.123

When should you see a doctor?

Arrange an appointment if bumps around your mouth do not go away, or the rash persists after stopping unprescribed steroid creams. Get assessed rather than continuing home treatment if the diagnosis is uncertain. If the rash is accompanied by pink eye, tell your clinician; an eye specialist referral can be needed. Bring details of your skincare and steroid use so treatment can address likely triggers.257