What causes perioral dermatitis?

Why do steroid creams cause problems?

Steroid creams can temporarily calm the rash, then make it more extensive and inflamed with continued use. When the cream is stopped, the rash can flare, encouraging another application and keeping the cycle going. Stronger products and prolonged use are particular concerns. Hydrocortisone counts as a steroid, even when bought without a prescription. Steroid exposure can also come from inhalers, nasal sprays or tablets, rather than a cream deliberately applied around the mouth.234

What else can trigger it?

Possible triggers to review include:

• Skincare and cosmetics: thick moisturizers, heavy face creams, makeup and sunscreen.
• Dental products: fluoride toothpaste, chewing gum and dental fillings have been associated with the rash.
• Hormonal changes: pregnancy and other hormonal changes are possible triggers. Oral contraceptives have been linked both to triggering and improving the condition.
• Other exposures: face masks and improper use of activated oxygen with CPAP equipment have also been linked.

A trigger list is not a list of things everyone must avoid. Irritation or an allergy to something touching the skin is one possibility. Changes in the skin barrier, the protective outer layer, and the microorganisms living on the skin are other proposed explanations. For the related form around the eyes, heat, cold, wind, ultraviolet light and emotional stress are also listed as possible triggers.456

Is it an infection or something you ate?

Perioral dermatitis is not contagious. Bacteria, yeast and mites have been proposed as contributors, but their exact role remains uncertain. No food or drink is known to cause or worsen perioral dermatitis; chewing gum is a separate reported association. An antibiotic prescription does not necessarily mean you have a bacterial infection, because antibiotics are also used to reduce the inflammation.1457

How do you know it is perioral dermatitis?

The rash usually consists of clusters of small bumps around the mouth, sometimes extending around the nose or eyes. Skin can be dry, flaky, itchy or burning, although discomfort is not always present. Bumps can look red or skin colored, and a narrow strip beside the lips often stays clear. Unlike acne, perioral dermatitis does not produce blackheads or whiteheads. A clinician usually diagnoses it by examining the rash; unusual or treatment resistant cases sometimes need further testing.134

What should you do about possible triggers?

1. 1Review your medicines. If you are using hydrocortisone without medical advice, stop treating the rash with it. Before changing any prescribed steroid, including an inhaler, contact the prescriber. A supervised taper is sometimes needed.
2. 2Reduce facial products. Pause cosmetics and heavy face creams unless your clinician advises otherwise. Removing cosmetics is part of the practical plan, so the makeup bag can remain packed without remaining on duty.
3. 3Wash gently. Water alone is one option during the flare; another is a mild, fragrance free cleanser. Washing with water alone is a valid skincare option, despite its disappointing lack of packaging.
4. 4Get persistent bumps checked. Bring a list of skincare products, toothpaste and medicines so your clinician can review possible triggers and choose treatment.

Expect gradual improvement over weeks to months, not immediate clearing after removing a trigger. Some people need topical medicine or oral antibiotics, and the rash can return. Tell the prescriber if you are pregnant, because antibiotic choice changes. If the rash involves your eyes and you develop pink eye, seek medical assessment; an eye specialist referral can be needed.2345