Perioral dermatitis

If you have a rash around your mouth, you may have perioral dermatitis. Perioral (which literally means “around the mouth”) dermatitis is a facial rash that resembles acne but is specifically located on the skin around the lips, the nostrils, the eyes and some people get it around their genitals. If you have the rash around any of these areas, your dermatologist may say you have “peri-orificial dermatitis”. The more restrictive term, “perioral dermatitis”, is often used when the eruption is confined to the skin in the lower half of the face, particularly around the mouth. Periocular dermatitis may be used to describe the rash affecting the eyelids. Perioral dermatitis is red and can be bumpy or scaly.

Peri-orifical dermatitis is actually a more accurate name for this rash. “Peri” means “around” and “orifical” refers to “an opening.” No matter where this rash appears though, people often refer to it as perioral dermatitis. That literally means peri (around) oral (the mouth).

This rash often looks like small, red, acne-like breakouts in people with light-colored skin and skin-colored breakouts in people who have skin of color.

Whether red or skin colored, this rash can itch. Sometimes, the rash causes a burning sensation.

It’s also possible that you won’t have any itching or burning. You’ll likely have dry and flaky skin where you have the rash, though.

It’s not entirely clear what causes perioral dermatitis. Something may be irritating your skin, such as a skin care product or toothpaste. It’s also possible that you’re allergic to something that’s touching your skin.

Many people develop perioral dermatitis rash when they apply a corticosteroid medicine to their skin for too long. That’s why it’s so important to follow the directions for taking medications. Be sure to follow the directions on medications that you can buy without a prescription and your doctor’s instructions for using all medications.

There are usually several causes of perioral dermatitis including:

Chronic use of topical steroid creams.
Inhaled prescription steroid sprays via the mouth or nose.
Overuse of facial creams and/or moisturizers.

Perioral dermatitis is a common skin problem that usually occurs in adult women aged 15 to 45 years. Older women can also be affected. Infrequently, men and children with darker skin can also be affected by perioral dermatitis. People with periorificial dermatitis are often using topical or inhaled corticosteroids.

Children are otherwise well, but they develop small pink bumps around the mouth and sometimes around the nose and eyes.
The rash may be mildly itchy (pruritic) and it may come and go (wax and wane) over time.
Using a topical steroid may trigger perioral dermatitis.
Fluorinated dental care products and skin products containing petrolatum, paraffin, or isopropyl myristate may also trigger the condition.

Is perioral dermatitis contagious?

No matter where this rash appears, the mouth or even the genitals, you cannot catch this rash. It’s not contagious.

The exact cause of perioral dermatitis is unknown, but misuse or overuse of corticosteroid inhalers, nasal sprays and creams may play a role.

What causes perioral dermatitis?

The exact cause of perioral dermatitis is not understood. Perioral dermatitis may be related to:

Epidermal barrier dysfunction
Activation of the innate immune system
Altered cutaneous microflora
Follicular fusiform bacteria

Unlike seborrheic dermatitis, which can affect similar areas of the face, malassezia yeasts are not involved in perioral dermatitis.

Perioral dermatitis may be induced by:

Topical steroids, whether applied deliberately to facial skin or inadvertently
Nasal steroids, steroid inhalers, and oral steroids
Cosmetic creams, make-ups and sunscreens
Fluorinated toothpaste
Neglecting to wash the face
Hormonal changes and/or oral contraceptives

Perioral dermatitis prevention

Perioral dermatitis can generally be prevented by the avoidance of topical steroids and occlusive face creams. When topical steroids are necessary to treat an inflammatory facial rash, they should be applied accurately to the affected area, no more than once daily in the lowest effective potency, and discontinued as soon as the rash responds.

Perioral dermatitis signs and symptoms

Small red bumps (1–2 mm) or tiny pus-filled lesions (pustules) appear around the mouth, often with a clear area between the lip area and the rash. While this rash often develops around the mouth, it can also appear around your eyes or nose. You may have the rash around your mouth and nose or your nose and eyes. Sometimes there may also be dry or flaky skin in these areas.

The characteristics of facial perioral dermatitis are:

Unilateral or bilateral eruption on the chin, upper lip and eyelids in perioral, perinasal and periocular distribution
Sparing of the skin bordering the lips (which then appears pale), eyelids, nostrils
Clusters of 1–2 mm erythematous papules or papulopustules
Dry and flaky skin surface
Burning irritation

In contrast to steroid-induced rosacea, perioral dermatitis spares the cheeks and forehead.

Genital periorificial dermatitis has a similar clinical appearance. It involves the skin on and around labia majora (in females), scrotum (in males) and anus.

Perioral dermatitis complications

Granulomatous perioral dermatitis is a variant of perioral dermatitis that presents with persistent yellowish papules. It occurs mainly in young children and nearly always follows the use of a corticosteroid. There is a granulomatous perifollicular infiltrate on histopathology.

Steroid rosacea presents with steroid-induced, large facial papules, papulopustules and telangiectasia on the mid-face, including forehead and cheeks.

Rebound flare of severe perioral dermatitis may occur after abrupt cessation of application of potent topical steroid to facial skin.

How is perioral dermatitis diagnosed?

The presentation of perioral dermatitis is usually typical, so clinical diagnosis is usually straightforward. There are no specific tests.

Skin biopsy shows follicular and perivascular chronic inflammation similar to rosacea.

How to treat perioral dermatitis

Perioral dermatitis responds well to treatment, although it may take several weeks before there is a noticeable improvement.

Skin care can play an important role in treating this rash. You may need to switch to a mild, fragrance-free cleanser and be very gentle when you wash your face. You may need to use fragrance-free skin care products.

Oral or topical antibiotics for a few weeks may be very effective. Azelaic acid is a topical product that may be prescribed by your doctor or a dermatologist. Sometimes the condition recurs after treatment is stopped, but the same therapy may be repeated as needed.

To get rid of this rash, you may need to

Stop applying all face creams including topical corticosteroids including hydrocortisone cream, cosmetics and sunscreens (zero therapy).
Consider a slower withdrawal from topical steroid/face creams if there is a severe flare after steroid cessation. Temporarily, replace it by a less potent or less occlusive cream or apply it less and less frequently until it is no longer required.
Wash the face with warm water alone while the rash is present. When it has cleared up, use a non-soap bar or liquid cleanser if you wish.
Choose a liquid or gel sunscreen.

Topical therapy

Topical therapy is used to treat mild periorificial dermatitis. Choices include:

Erythromycin
Clindamycin
Metronidazole
Pimecrolimus
Azelaic acid

Oral therapy

In more severe cases, a course of oral antibiotics may be prescribed for 6–12 weeks.

Most often, a tetracycline such as doxycycline is recommended. A sub-antimicrobial dose may be sufficient.
Oral erythromycin is used during pregnancy and in pre-pubertal children.
Oral low-dose isotretinoin may be used if antibiotics are ineffective or contraindicated.

Perioral dermatitis toddler treatment

Metronidazole cream (a topical antibiotic) applied up to 2 times daily, gradually decreasing use as the condition improves.
Oral tetracycline for children older than 9, gradually decreasing use as the condition improves.
Oral erythromycin for children less than 9 years old, gradually decreasing use as the condition improves.
Topical antibiotics may help mild outbreaks.

Home remedies for perioral dermatitis

You may be able to get rid of perioral dermatitis rash on your own. To clear perioral dermatitis, you must stop applying all corticosteroids, including hydrocortisone cream, to your skin. If you’re using prescription corticosteroid, ask the doctor who prescribed it if you can stop applying it. If your doctor tells you to keep using a corticosteroid, ask if you can use another medication.

When you stop applying a corticosteroid or hydrocortisone cream, the rash can worsen. If this happens, it can be tempting to start using the cream or ointment again. Don’t. Using it again will only bring temporary relief. Each time you stop applying it, the rash can flare.

It’s also possible that if you continue to apply the corticosteroid medication, it will eventually cause the rash to worsen each time you apply it.

Stop all face creams, lotions, cosmetics, and sunscreens being used.
Stop any dental products with fluoride and anti-tartar ingredients until the rash has resolved, and then try a different dental product.
Wash with warm water alone until the rash improves, and then use a soap substitute to clean your face.

If the self-care measures are not helping after 4–6 weeks, seek medical advice.

How long will it take to get rid of perioral dermatitis?

Expect gradual improvement. This rash tends to clear slowly. It may take a few weeks or a few months to clear completely.

If you’re having trouble getting rid of a rash, you can seek medical advice from a dermatologist.

Perioral dermatitis prognosis

Perioral dermatitis sometimes recurs when the antibiotics are discontinued, or at a later date. The same treatment can be used again.

Perioral dermatitis