What do the bumps look and feel like?
| Clue | Perioral dermatitis | Acne |
|---|---|---|
| Bumps | Clusters of small raised bumps or pustules, which contain pus, often with a scaly surface. | Blackheads, whiteheads, raised pimples or pustules; deeper nodules and cysts are also possible. |
| Location | Usually around the mouth; also around the nose or eyes. A narrow strip beside the lip often stays clear. | Usually the face, chest or back. |
| Surrounding skin | Often dry and flaky. | Often oily or greasy. |
| Sensation | Can itch or burn, but neither symptom is required. | Can feel hot or painful, especially with deeper lumps. |
| Colour | Often red on lighter skin and skin coloured on darker skin. | Raised pimples can look pink or red on white skin and brown or purple on brown and black skin. |
These are clues, not a diagnosis. A clinician considers the appearance, distribution and timing of the bumps. Some acne lookalikes are difficult to distinguish, and tests for infection are sometimes needed.24
What causes each condition?
Acne develops when hair follicles become blocked with excess oil and dead skin cells. Bacteria can grow inside the blockage and cause inflammation and pus. Hormonal changes, certain medicines and greasy skin or hair products can contribute. The exact cause of perioral dermatitis is unknown. Possible triggers include steroid creams, cosmetics, toothpaste and hormonal changes. Young women are most likely to develop it, but it is also common in children.14
A rash beneath a mask is not automatically acne. Mask friction and the warm, humid environment underneath can promote both acne and perioral dermatitis.5
What should you do if perioral dermatitis seems likely?
- 1Check whether you are applying hydrocortisone or another steroid cream. Stop hydrocortisone used without your doctor's knowledge. Before changing any prescribed medicine, contact the prescriber.
- 2If the rash flares after stopping a steroid, do not restart it on your own. Restarting can give temporary relief followed by another flare when you stop.
- 3Reduce face creams and cosmetics. Depending on the rash, care can involve washing with warm water alone or using a mild, fragrance free cleanser. Wash gently.
- 4Arrange an examination if the bumps persist. Treatment can include medicines applied to the skin or oral antibiotics; the choice depends on the diagnosis and severity.
Reducing face creams can be part of treatment, so the bathroom shelf does not need to operate at full capacity.2
What changes if the diagnosis is acne?
Wash twice daily with a gentle cleanser, avoid scrubbing and do not squeeze spots. Choose products labelled noncomedogenic, meaning they will not clog pores. A pharmacist can advise on acne treatments such as salicylic acid or benzoyl peroxide.1
Retinoids clear pores and treat blackheads, whiteheads and some pimples; benzoyl peroxide reduces bacteria involved in acne. Dermatologists often direct topical retinoids to be applied in the evening. Follow the prescribed amount and frequency rather than adding more. If a retinoid irritates your skin, ask your dermatologist about adjusting the amount, frequency or moisturizer order.6
How long does clearing take?
Acne treatment takes at least 6 to 8 weeks before fewer breakouts begin to appear. Perioral dermatitis improves gradually and can take weeks to months to clear. Some prescribed courses last 6 to 12 weeks. The bumps can return, particularly if steroid creams are used again.346
When should you see a doctor?
Book an appointment for persistent bumps around the mouth or breakouts that are not improving with treatment. Seek medical help for deep, painful spots, scarring, hot and swollen skin, or symptoms affecting your mental health. An accurate diagnosis matters more than trying another acne product on an unexplained rash.14
Where this answer comes from
- 1Acnenhs.uk
- 2Acneiform eruptionsdermnetnz.org
- 3Red rash around your mouth could be perioral dermatitisaad.org
- 4Perioral dermatitis: MedlinePlus Medical Encyclopediamedlineplus.gov
- 5The Struggle with Maskne is Very Realhealth.clevelandclinic.org
- 6Acne: Diagnosis and treatmentaad.org
