Why do you get perioral dermatitis?

What can trigger it?

• Steroid medicines. Facial steroid creams, including hydrocortisone, are a common link, especially with prolonged use. Nasal sprays, inhalers and oral steroids are also associated with perioral dermatitis. Contact with facial skin can be accidental.
• Skincare and cosmetics. Heavy face creams, makeup and some sunscreens are associated with the rash. Thick creams and ointments that seal the skin can worsen it.
• Toothpaste and dental materials. Toothpaste can irritate the skin or cause an allergic reaction. Fluorinated toothpaste and dental fillings are among the possible triggers.
• Hormonal changes. Flares have been observed during pregnancy, before periods and with oral contraceptive use.
• Environmental exposure. Sunlight, heat and wind seem to worsen an existing rash.

One possible explanation involves the skin barrier, the outer layer that helps keep irritants out and water in. When that barrier is disrupted, irritating substances can enter more easily and skin loses more water. Dryness then encourages more product use, which can add further irritation.1

Perioral dermatitis is not contagious. Bacteria, yeast and mites have been found in affected skin, but their role remains uncertain. No food or drink is known to cause or worsen it, so cutting out foods is not an established way to identify the trigger.134

Who gets it, and what does it look like?

Young and middle aged women are most commonly affected, but men and children get it too. The rash usually forms small bumps around the mouth, sometimes spreading around the nose or eyes. Bumps can look red on lighter skin and skin colored on darker skin. Dryness, flaking, itching or burning can accompany them.34

A strip of skin immediately beside the lips is often spared. Perioral dermatitis can resemble acne, but blackheads and whiteheads are not typical. Contact dermatitis and rosacea can also look similar, so the location alone is not enough to diagnose the rash.1245

What should you change first?

Pause makeup and unnecessary face creams, even the ones whose packaging reads like a letter of recommendation.2

1. 1Review steroid use. Stop hydrocortisone used without your doctor's knowledge. For a prescribed facial steroid, contact the prescriber before changing it; a gradual withdrawal or replacement medicine can be needed.
2. 2Reduce skincare. Wash gently with warm water alone while the rash is active. If a cleanser is needed, use a mild, fragrance free option rather than scrubbing.
3. 3Adjust products for dryness and sun protection. Avoid heavy, sealing creams and ointments. A bland moisturizer without additives can help dryness, and a gel or liquid sunscreen is an option.
4. 4Keep medically necessary medicines. Continue necessary nasal, inhaled or oral steroids. Rinsing your face and mouth after nasal sprays or inhalers can help reduce contact.

The goal is fewer unnecessary products, not a replacement shopping list with better branding.2

Stopping a facial steroid can temporarily worsen the rash. Do not restart it on your own to calm that flare: relief can be temporary, with another flare when you stop again.3

When should you get medical help?

See a clinician if bumps around your mouth do not go away, or facial redness lasts more than two weeks. A dermatologist can confirm the diagnosis and prescribe a topical medicine or an oral antibiotic. Mention pregnancy because it changes antibiotic choice.246

Expect gradual improvement over weeks to months, not immediate clearing. Treatment sometimes lasts six to twelve weeks. The rash can return, particularly if facial steroid creams are used again.23