How can you tell them apart?
| Clue | Perioral dermatitis | Atopic dermatitis |
|---|---|---|
| Appearance | Grouped small bumps, sometimes with pus or tiny blisters; scaling can occur. | Dry, scaly patches that can crack, crust or become thickened. |
| Location | Around the mouth, often leaving a narrow clear strip beside the lips; the nose and eyes can also be involved. | Often elbows, knees and hands; commonly the face in babies and around the eyes in adults. |
| Sensation | Burning, tenderness or itching. | Often intense itching, sometimes severe enough to disturb sleep. |
| Main treatment difference | Avoid irritating or heavy skin products; prescription antibiotics are sometimes needed. | Regular moisturisers and prescribed steroid treatments are main treatments. |
Colour alone is not a reliable dividing line. Atopic eczema can look red, purple, grey, white, lighter or darker than surrounding skin. Perioral bumps can be skin coloured rather than red. Both conditions can affect the face, so location alone cannot settle the diagnosis.36
What causes each condition?
Atopic dermatitis involves genetic and environmental factors and a skin barrier that loses moisture too easily. A family history of eczema, asthma or hay fever raises the likelihood. It is not simply an allergic reaction. Perioral dermatitis has no fully understood cause, but steroid exposure and cosmetic use are associated with it.256
Why the same skincare can be the wrong treatment
For diagnosed atopic eczema, apply an emollient, a moisturising treatment, at least twice daily, including when symptoms improve. Wash with an emollient instead of soap. Children can need more frequent applications. Prescribed steroid creams calm eczema flares; the clinician chooses the strength and duration, and application is usually once daily to inflamed areas.35
For perioral dermatitis, reducing facial cosmetics and other topical products is part of treatment. Warm water alone can be used for washing until the rash clears. Heavy creams and ointments can worsen the rash; a bland, light emollient can help dryness, and a gel or liquid sunscreen can be used.6
Do not start hydrocortisone on an unexplained mouth rash. If you already use a prescribed facial steroid, ask the prescriber how to stop: stronger steroids can need gradual withdrawal, and stopping can temporarily trigger a flare. Continue medically necessary inhaled, nasal or oral steroids; rinsing the face and mouth after inhaled or nasal treatment can help reduce exposure.16
How long does treatment take?
Perioral dermatitis treatment commonly lasts 4 to 8 weeks, sometimes longer. Options include topical metronidazole or erythromycin and oral antibiotics. Pregnancy and a child's age change antibiotic choices, so tell the prescriber. In children, topical antibiotic treatment typically clears the rash in 3 to 8 weeks. Atopic dermatitis has no cure, but treatment can control symptoms; flares and quieter periods are typical.136
When should you see a doctor?
Arrange assessment if facial redness lasts more than two weeks, treatment is not helping, or itching disrupts sleep or daily activities. Adults can develop eczema for the first time, so no childhood history does not exclude it. Seek urgent care for eczema that suddenly spreads or worsens, becomes painful, swollen or warm, leaks fluid or develops pus, especially with fever or feeling unwell.3457
Where this answer comes from
- 1Periorificial dermatitis in childrendermnetnz.org
- 2Atopic dermatitis: MedlinePlus Geneticsmedlineplus.gov
- 3Atopic eczemanhs.uk
- 4Can you get eczema as an adult?aad.org
- 5Atopic eczema in children (print version)whittington.nhs.uk
- 6Periorificial dermatitis (Perioral Dermatitis): Authoritative guidancedermnetnz.org
- 710 reasons your face is redaad.org
