What is perioral dermatitis?
Perioral dermatitis is a skin condition that causes red spots, pustules, scaling and redness. The skin becomes very sensitive. Many sufferers will also complain of stinging, burning and itching too.
Perioral dermatitis is when this rash occurs around the mouth. Perioral is pronounced perry-oral and means around the mouth.
The same rash can also affect the skin around the nose and the eyes. The mouth, nose and eyes are orifices of the face. This rash is also called peri-orificial (pronounced perry-oree-fish-ul) dermatitis.
Perioral dermatitis and periorificial dermatitis can be quite distressing and upsetting. Luckily several treatments are available that can help.
Symptoms of perioral dermatitis
The most common complaint is that red spots develop, in the skin around the mouth. Some of the spots may have a pus head on them (these are pustules). Sometimes very small blisters may be seen.
Redness, flaking and peeling of the skin is very common.
What is the difference between perioral dermatitis and acne?
Perioral dermatitis can sometimes be confused with acne. However, perioral dermatitis is not acne.
Acne differs from perioral dermatitis as acne causes comedones whereas perioral dermatitis does not. The spots in acne also tend to be larger and deeper. There may be cysts and scars. Spots are usually on the jawline, cheeks and forehead.
Perioral dermatitis does not usually cause scars in the same way that acne can (but it can cause prolonged redness).
It is possible to have both acne and perioral dermatitis at the same time.
What is the difference between perioral dermatitis and rosacea?
Perioral dermatitis can sometimes be confused with rosacea. However, perioral dermatitis is not rosacea.
The spots in rosacea are usually found on the central third of the face, including on the forehead, nose and chin. The spots in perioral dermatitis are located around the mouth, around the nose and around the eyes. Rosacea will also cause flushing and redness.
To confuse things, the spots in perioral dermatitis look a lot like the spots in rosacea when they are examined down the microscope.
Also, It is possible to have both rosace and perioral dermatitis at the same time .
What is the difference between perioral dermatitis and eczema?
Another name for eczema is dermatitis. However perioral dermatitis is not eczema even though it shares a similar name. Eczema does not cause pimples. However, perioral dermatitis can occur in someone who is treating their eczema with steroid creams as a side effect.
What causes perioral dermatitis?
The causes of perioral dermatitis are not entirely clear. Problems with the skin barrier function appear to be a major issue in perioral dermatitis.
The skin barrier is the top most layer of cells on the skin. These are bound tougher by lipids (fats) such as ceramides. They are a bit like bricks and mortar. They form a barrier that keeps the outside out, and the inside in. The barrier stops irritants from disturbing the skin and also prevents dehydration and water loss.
It is very possible that when the skin barrier is not functioning properly, common things in the environment such as sun light, environmental pollution, cleansers, toners, sunblocks and other products may start causing an immunological reaction that leads to perioral dermatitis.
Triggers that may cause or flare perioral dermatitis are:
- Excessive skin cleaning and washing.
- Using too many acids on the skin
- Applying very thick layers of make up, sunblock and moisturisers
- Skin care products that have a lot of alcohol based preservatives
- Immunological reactions to bacteria and yeasts on the skin
- Sun light
- Steroid creams (even steroid nasal spray and steroid inhalers may cause perioral dermatitis)
- Stress
- Perioral dermatitis can flare at various stages of the menstrual cycle from hormonal changes
- Wearing masks. Some cases of maskne may actually be perioral dermatitis.
Perioral dermatitis is not contagious.
Can perioral dermatitis be treated?
Fortunately there are very effective treatments for perioral dermatitis. These are the simple steps to follow:
1. Completely simplify your skin care regime and use just a cleanser and moisturiser.
The first step is to improve the skin barrier function. Use a very gentle pH neutral skin cleanser and a non-occlusive moisturiser. A light moisturiser several times a day is better than a heavy moisturiser applied once. This will allow the skin to breathe, protect it from water loss, but not clog pores. You will need to stop exfoliating products, acids, peels, scrubs, masks, astringents and any thing else that can disrupt the skin barrier.
2. Don’t suffocate your skin with anything thick
This means no thick layers of make up, sun block or other products. You might need to cold turkey with all your products for a while until your skin is under control again.
3. Use active ingredients to control perioral dermatitis
These are the non medicated products that may help perioral dermatitis. Use creams rather than gels or tonics:
- Azaleic acid
- Tea tree oil
- Aloe vera
4. Use prescription medications under the guidance of a Dermatologist.
Sometimes you will need prescription treatments to help control perioral dermatitis. Common prescription medications your doctor may recommend for you to control perioral dermatitis include the following listed below (creams are usually better than gels or tonics):
- Metronidazole
- Clindamycin
- Erythromycin
- Pimecrolimus
- Ivermectin
For very severe cases you may also need oral medications including:
- Tetracycline antibiotics
- Erythromycin antibiotics
- Isotretinoin
5. If you are on steroid medication, you will need to look at ways in coming off steroid creams and changing over to non steroidal treatments.
As steroids can trigger perioral dermatitis, you will need to review ways in which you can minimise the strength of steroid products used or better still come off them all together with your Dermatologist.
Can perioral dermatitis come back?
Sometimes, perioral dermatitis is a one off rash that clears up completely for good once it has been treated.
However more often than not perioral dermatitis may keep coming back in waves.
Making sure your skin care keeps your skin barrier healthy will help make sure perioral dermatitis doesn’t come back. Sometimes you may need to repeat medicated creams and tablets in order to stop an outbreak as soon as you think one is coming on.
Consultations for perioral dermatitis.
We offer consultations for perioral dermatitis. If you are interested in a consultation for perioral dermatitis in Birmingham them contact us on 0121 2854540 to arrange an appointment.
References
Author details
Author: Dr Sajjad Rajpar
Date last reviewed: 1 Oct 2020
Conflict of interest and disclaimer
This information is based on the views of a UK Consultant Dermatologist (a doctor who is on the specialist register for Dermatology, the equivalent of which is ‘Board certified’ in the USA). This information is intended for patients of this Clinic and under our care only. No part of this document should be construed as medical advice. Practices vary nationally and internationally, and we do not wish to contravene advice you have been provided by your own Physician.
