Perioral dermatitis vs seborrheic dermatitis

What does each rash look like?

Perioral dermatitis can look like acne, but it lacks blackheads, whiteheads, deep cysts and nodules. Small bumps are called papules. Seborrheic dermatitis is not always red: on darker skin it can look pink, slightly purple or lighter than nearby skin. Neither condition is contagious.124

Why steroid cream matters

Topical steroids can briefly improve perioral dermatitis, then make the bumps more extensive and inflamed. Stopping can cause a temporary flare. If you use a prescribed steroid cream, inhaler or nasal spray, ask your prescriber how to manage it rather than changing it yourself. Accidental nasal spray exposure around the eyes can also contribute; spray technique deserves a review.345

What should you do while waiting for a diagnosis?

1. 1Wash gently with warm water and a gentle cleanser. Avoid scrubbing and pat the skin dry.
2. 2Pause recently added cosmetics or lotions rather than adding more products directly onto the rash.
3. 3For suspected perioral dermatitis, avoid heavy oily face creams. Water based makeup and sunscreen are alternatives when these products are needed.
4. 4Write down when the rash started, where it appears and what makes it better or worse.

Heavy face creams and cosmetics deserve a place in the product history, even if the packaging would prefer to discuss radiance.4

How do the treatments differ?

Perioral dermatitis treatment starts with removing contributing products and managing steroid exposure. A clinician can prescribe antibiotics such as doxycycline to reduce inflammation, or topical medicines such as metronidazole. Topical treatments can be difficult to tolerate, especially around the eyes. Pregnancy changes the medicine choice; oral erythromycin is an option a clinician can consider when treatment is needed.145

Seborrheic dermatitis treatment can include dandruff shampoo and medicine applied to the skin for a short time. Dandruff shampoo often controls scalp flaking; contact a healthcare provider if it does not work. A facial rash needs a treatment plan suited to that area, rather than assuming a scalp routine is the whole answer.67

How long does improvement take?

Perioral dermatitis often needs weeks to months of treatment, and it can return after clearing. Seborrheic dermatitis has no cure, but treatment can reduce itching and lessen or clear the rash. Teenagers and adults can have recurring flares, often in winter or early spring and during stress. A clear spell does not necessarily mean the condition has finished.12

When should you see a doctor?

Make an appointment if facial redness lasts more than two weeks, home care does not help or symptoms worsen. A clinician usually diagnoses perioral dermatitis by examining the skin. Bring the names of creams, makeup and sprays to the appointment, because 'the one in the nice bottle' is not much of a product name.16

Seek prompt medical advice for fever, swelling, very tender areas or streaks of redness, which can indicate infection. Seek emergency help if a rash comes with trouble breathing, a tight throat or facial swelling.3