What is Perioral Dermatitis? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Signs and Symptoms of Perioral Dermatitis

People with perioral dermatitis have a visible rash around their mouth, says Peter Lio, MD, a dermatologist at Northwestern Memorial Hospital in Chicago.

"Typically, it would present as small red papules, or bumps, around the mouth and sometimes nose and eye areas,” he says. “Unlike mild irritation in these areas, this rash persists for weeks and beyond.”

Additionally, perioral dermatitis is often associated with redness and scaling, says Arielle Nagler, MD, a dermatologist at NYU Langone Health.

“Patients often complain of itching and burning,” she says. “Since certain topicals can exacerbate perioral dermatitis and treatments are all by prescription, medical care is recommended.”

Common Questions & Answers

While the cause of perioral dermatitis is unknown, dermatologists believe certain things may trigger the skin condition. These include the use of topical steroids around the mouth, including inhaled steroids for asthma, skincare products, and irritation from face masks.

The first step to treat perioral dermatitis is to stop using topical steroids around the mouth and any potential triggering skin-care products. If these initial steps do not clear up the rash, your doctor may prescribe topical treatments or oral antibiotics.

There is no FDA-approved treatment specifically for perioral dermatitis. But stopping the use of topical steroids and other triggers around the mouth and following your doctor’s treatment plan will help ensure the condition clears up as quickly as possible.

In some instances, perioral dermatitis will go away on its own, but usually the help of a dermatologist is needed. Even with treatment, perioral dermatitis may take weeks, months, or even years to completely clear.

For individuals with perioral dermatitis, experts recommend a mild, fragrance- free cleanser and fragrance-free moisturizer with an SPF of 30 for use every day.

Causes and Risk Factors of Perioral Dermatitis

“Using steroids around the mouth — including inhaled steroids for asthma — is a common trigger in children,” Dr. Lio says.

During the COVID-19 pandemic, dermatologists have seen a rise in perioral dermatitis as a result of face masks. “Generally, dermatoses, or rashes, associated with masks have gone up in our practice over the last year or so,” says Anna Lien-Lun Chien, MD, an associate professor of dermatology at Johns Hopkins University School of Medicine. “There’s a number of different rashes that can occur and perioral dermatitis is one of them.”

“Unfortunately with the mask in place, it creates a different environment,” she continues. “It changes the barrier of the skin in that area. Especially for an individual who’s more sensitive or prone to this inflammation they can start developing those breakouts.”

In some cases of perioral dermatitis, a skin-care product or even a particular toothpaste may be the culprit, Lio says.

The skin condition can affect anyone at any age, but children and women are most affected, Lio says.

How Is Perioral Dermatitis Diagnosed?

“Any new rash is potentially worth seeking medical care for, but especially more severe and persistent rashes would warrant reaching out,” Lio says. “While there are not too many concerning things that can mimic this, sometimes bacterial or viral infections can be similar, and those should be promptly diagnosed and treated.”

He notes that most patients will first see their primary care doctor, but if the rash is not responding to treatment or the diagnosis is unclear, a visit to a board-certified dermatologist can be helpful.

Duration of Perioral Dermatitis

“There is not a lot of data on recurrence after resolution; however, in my experience recurrences are common and can even occur years after successful treatment,” Dr. Nagler says.

Treatment and Medication Options for Perioral Dermatitis

There is no specific FDA-approved treatment for perioral dermatitis, Lio says. Sometimes may clear up on its own. Yet some people will need the help of a healthcare provider. There are several approaches you can take to relieve symptoms.

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If wearing face masks during the COVID-19 pandemic are the culprit, Dr. Chien recommends taking mask breaks when appropriate, and if your line of work allows, choosing a face mask that has a lower chance of irritating the skin. “Cotton or polyester blends tend to be a little more gentle on the skin,” she says. “Something that’s more smooth in texture will minimize that friction and breaking down of the skin barrier.”

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For cases that don’t respond to these practical steps, dermatologists will typically treat perioral dermatitis in a similar way to rosacea, Lio says.

“The first line treatment is a topical therapy that we might use for rosacea: metronidazole cream or ivermectin cream, usually applied twice daily,” he says. “Sometimes I will add in a sulfur-based cleanser as well.”

If that doesn’t work or if the condition is severe, oral antibiotics like doxycycline may be prescribed, Lio says.

“In children, sometimes we will use azithromycin or erythromycin instead,” he says. “Usually, a few weeks of these anti-inflammatory antibiotics seems to break the cycle.”

Prevention of Perioral Dermatitis

Make sure your face masks are clean and that they fit properly, Chien says. Not only will this better protect you from COVID-19, but it will minimize irritation and breakdown in skin barrier.

Keep your skin-care routine simple. “Use a mild cleanser followed by a light moisturizer to protect the skin each morning,” Lio advises.

Sun care is key, too. Make sure to protect yourself by wearing SPF every day. “It could be an oil-free facial lotion with SPF 30 that you can use daily,” Chien says.

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Avoid going back to using products that irritated you before you developed the rash.

“These seem to be generally helpful for many patients, but the truth is that we don't fully understand why this condition develops despite many theories,” Lio says.

Complications of Perioral Dermatitis

Still, it is important not to resume the medication unless directed by your healthcare provider. Over time and with appropriate treatment, the rash usually improves.

“Perioral dermatitis is generally thought to be benign and is usually self- limited, although it can be uncomfortable, unsightly, and can persist for many months in some cases, and even years for some patients,” Lio says.

Research and Statistics: How Many People Have Perioral Dermatitis?

There isn’t any hard data on the number of people living with perioral dermatitis, but dermatologists report it is relatively common.

Perioral dermatitis is seen more frequently in fair-skinned people than in those with darker skin. But Chien adds another caveat: “Rashes, inflammation, and redness on the skin is more difficult to appreciate in African American skin, so sometimes the diagnosis may be missed in that population,” she says.

Perioral dermatitis has also been reported in children with no significant difference seen in gender or race among kids.

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