What does each rash look like?
| Clue | Perioral dermatitis | Eczema |
|---|---|---|
| Appearance | Clusters of small inflamed bumps, often with dry or flaky skin. | Dry, scaly patches; bumps, cracks, crusting or thickened skin can occur. |
| Location | Usually around the mouth; can also surround the nose and eyes. The lips are usually spared. | Can affect the face and lips, as well as the hands, neck, elbows, knees and other areas. |
| Sensation | Can burn or itch, but neither is required. | Itch is a central feature of atopic eczema. Contact dermatitis can also burn or sting. |
| Skin tone | Bumps can look red on lighter skin or skin colored on darker skin. | Patches can look pink, red or purple on lighter skin, and purple, brown or gray on darker skin. |
| Treatment | Reduce irritating products; a clinician can prescribe topical medicines or oral antibiotics. | Regular moisturizing, avoiding triggers and prescribed medicines, sometimes including topical steroids. |
A narrow strip of unaffected skin immediately beside the lip supports the perioral dermatitis pattern. Neither dryness nor bumps settles the question alone, because both conditions can have both. Atopic eczema is more likely to have a recurring history of itch and patches elsewhere, including the bends of the elbows or knees.46
What should you do while the diagnosis is unclear?
- 1Review steroid use first. If you have been applying hydrocortisone without medical advice to a rash that could be perioral dermatitis, stop. Ask the prescriber before changing any prescription steroid, including an inhaled or oral medicine.
- 2Remove irritating cosmetics and heavy facial products. For suspected perioral dermatitis, use a mild cleanser and a gentle, fragrance free moisturizer without exfoliants rather than layering on more treatments.
- 3If eczema is confirmed, moisturize dry skin throughout the day and apply moisturizer to damp skin after bathing. Use prescribed topical medicines as directed.
- 4Arrange an examination if the rash persists or the diagnosis remains uncertain. Bring details of where it started, how long it has lasted, products used and any steroid treatment.
Once perioral dermatitis clears, reintroduce skincare products one at a time, rather than giving the whole bathroom cabinet a simultaneous comeback, however strongly the matching packaging suggests a group booking.1
How do treatment and recovery differ?
Perioral dermatitis treatment can include topical metronidazole, erythromycin or other medicines; more severe cases sometimes need oral antibiotics. Pregnancy and age affect medicine choices: oral erythromycin is an option used in pregnancy, and oral tetracyclines should be avoided in children under 12. A clinician should select the treatment.147
Perioral dermatitis usually improves gradually over weeks to months. Stopping a topical steroid can temporarily worsen the rash; do not restart it unless your clinician directs you to. In children, topical antibiotic treatment typically takes 3 to 8 weeks to clear the rash. Atopic eczema instead follows a recurring course, with flares and periods of improvement.2467
Seek a reassessment if treatment is not helping, the pattern is unusual, or itching disrupts sleep and daily activities. Diagnosis usually starts with your history and a skin examination; contact allergy testing or, occasionally, a skin biopsy can help distinguish similar rashes. If a facial rash accompanies pink eye, contact a clinician, who can arrange an eye assessment.467
Where this answer comes from
- 1Perioral dermatitis: Symptoms, treatment, and preventionhealth.harvard.edu
- 2Red rash around your mouth could be perioral dermatitisaad.org
- 3Eczema: What It Is, Symptoms, Causes, Types & Treatmentmy.clevelandclinic.org
- 4Periorificial dermatitis in childrendermnetnz.org
- 5Eczema types: Contact dermatitis signs and symptomsaad.org
- 6Guidelines for the diagnosis and assessment of eczemadermnetnz.org
- 7Perioral Dermatitis: Treatment, Symptoms & Causesmy.clevelandclinic.org
