What is perioral dermatitis?
Perioral dermatitis is a common inflammatory skin condition that mostly affects the lower face. Despite the name, it isn’t a form of eczema. It’s more common in women but can affect men and children too.
It usually starts as a rash around the mouth, but it can spread to the skin beside the nose and around the eyes. When it affects more than one of these areas, it’s sometimes called periorificial dermatitis. The condition is not contagious, so you can’t catch it from someone or pass it on.
Symptoms of Perioral Dermatitis
Symptoms usually build up gradually over a few weeks. You might notice:
- Clusters of small red, pink or skin-coloured bumps around the mouth and chin
- Bumps in the creases between your nose and mouth, or around the nostrils and eyes
- Small pus-filled spots mixed in with the bumps
- Dry, flaky patches on and around the rash
- A burning, stinging or tight feeling, sometimes with itching
- A thin strip of clear skin right next to the lips
On darker skin tones, the bumps may look purple, brown or darker than your usual skin colour rather than red.
How is perioral dermatitis diagnosed?
Perioral dermatitis is diagnosed by looking at the skin, and tests aren’t usually needed. A pharmacist or doctor will check where the bumps sit on your face and ask about the products you’ve been using, including whether you’ve recently applied a topical corticosteroid to your face.
The rash can look a lot like acne, rosacea or seborrhoeic dermatitis, so getting the right diagnosis is important. Some creams used for other facial rashes can make perioral dermatitis worse. If there’s any doubt, a swab or skin scraping may be taken to rule out an infection.
Perioral Dermatitis Causes and Triggers
The exact cause isn’t known, but certain things are closely linked to flare-ups:
- Any topical steroid used on the face, including mild over-the-counter hydrocortisone
- Steroid nasal sprays, inhalers and tablets
- Heavy face creams, moisturisers and make-up
- Thick or greasy sunscreens
- Fluoride toothpaste in some people
- Hormonal changes, such as starting the contraceptive pill or the days before a period
- Heat, wind and UV light, which can make an existing rash worse
Steroid creams are the most common link. They can initially calm the redness, which makes it tempting to keep using them, but over time they make the rash worse and it often flares when you stop.
How to Treat Perioral Dermatitis
Most perioral dermatitis treatments start the same way: stop using anything that could be irritating the skin. Dermatologists call this zero therapy, and in mild cases it can be enough to clear the rash on its own. If the rash doesn’t settle, the next step is a prescription medicine.
Oral tetracycline antibiotics, such as doxycycline and lymecycline, are the most widely used treatments for perioral dermatitis. They help reduce inflammation in the skin, and most people see their rash clear within 6 to 12 weeks. They aren’t suitable during pregnancy or breastfeeding, so let us know in your consultation if either applies to you.
Topical options include metronidazole, erythromycin and azelaic acid, found in Finacea and Skinoren. Metronidazole and erythromycin have the most evidence behind them for perioral dermatitis. They suit milder rashes, but some people find their skin too sensitive for creams and gels while the rash is active.
Skincare Tips for Perioral Dermatitis
A few changes to your routine can help, whichever treatment you use:
- Stop using face creams, make-up and steroid creams unless a healthcare professional tells you otherwise
- Wash your face with warm water alone until the rash clears, then switch to a gentle soap substitute
- Use a thin layer of light, fragrance-free, oil-free moisturiser if your skin feels very dry
- Pick a liquid or gel sunscreen over thick creams
- Wash your hands after applying steroid cream elsewhere on your body, so none ends up on your face
- Rinse your face and mouth after using a steroid inhaler or nasal spray
- Try not to pick or squeeze the spots
Don’t stop a prescribed steroid inhaler, nasal spray or tablet without speaking to your GP first.
When to Get Advice About Perioral Dermatitis
Speak to a pharmacist or GP if your rash hasn’t improved after a few weeks without skincare products, if it’s spreading or if you’re not sure what it is. It’s also worth getting advice if you’ve been using a steroid cream on your face, as stopping can cause a short-lived flare. If the diagnosis isn’t clear, your GP may refer you to a dermatologist.
Our pharmacy team provides perioral dermatitis treatment UK-wide through our online clinic. If you’d like advice before choosing anything, you can book an online pharmacist consultation.
