Perioral Dermatitis

Perioral dermatitis is a variant of rosacea that appears as tiny red bumps (papules) around the mouth. It usually spares the skin closest to the lips (the vermillion border). It occurs most commonly in adult women, but may also affect men or children.

The bumps may itch or burn, and they may be mistaken for acne. The surrounding skin may be pink, dry, and flaky, and it may peel. On rare occasions, the rash may appear near the eyes, nose, cheeks, or forehead. It doesn’t usually affect the lips, but they make appear paler than usual in contrast to the rash.

What causes perioral dermatitis?

The cause of perioral dermatitis is not known, but there are several possible triggers, including:

  • Topical corticosteroids, which can be applied accidentally to facial skin by hands that have treated other parts of the body. This is one of the most common causes of perioral dermatitis. Inhaled steroids used for the treatment of asthma have also been associated with perioral dermatitis.
  • A skin reaction to certain facial products, including cleansers, creams, moisturizers, cosmetics, and sunscreens.
  • Bacteria or yeasts that live and multiply in facial hair follicles.

How is perioral dermatitis diagnosed?

Your physician can probably diagnose perioral dermatitis just by inspecting your skin, although sometimes a bacterial or yeast culture may be necessary to rule out an infection.

If acne, rosacea, or another skin condition is suspected, your doctor may scrap some cells from the skin’s surface to examine under a microscope. On rare occasions, a blood test or skin biopsy may also be necessary to rule out other causes of the rash.

How is perioral dermatitis treated?

Fortunately, perioral dermatitis usually responds well to treatment, but it may require several months of treatment to see a signficant response.

Options include topical medications, such as metronidazole (MetroGel®), tacrolimus (Protopic®), or pimecrolimus (Elidel®), or oral antibiotics, such as doxycycline. A low-dose of doxycycline may be prescribed for use to help control the inflammation. A commerically available from of low-dose doxycycline (Oracea®) is commonly prescribed for the treatment of rosacea.

While following your medication regimen, it’s a good idea to stop using all face creams , makeup, and heavy sunscreens (continue protecting your face from the sun with a lighter, gel-based sunscreen). During treatment, use only water to wash your face.

Speak to your physician if you are using a corticosteroid on your skin (i.e. hydrocortisone) or by mouth (i.e. prednisone). It may be important to stop all use of topical corticosteroids to bring perioral dermatitis under control, though symptoms may initially worsen.

How can I prevent perioral dermatitis?

  • Avoid using any topical steroids on your face, unless specifically directed by your physician.
  • Keep track of possible triggers, such as certain moisturizers, cleansers, cosmetics, or even certain brands of toothpaste.
  • Once you have finished with a course of treatment, use a non-soap cleanser when washing your face.  

What is the prognosis?

Most people with perioral dermatitis see some improvement within a month or two of using topical or oral antibiotics.

The disorder does tend to recur in some people, so repeat treatments may be necessary. If it recurs after a course of treatment, the same treatment can usually provide benefit if used again.

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Last updated: 12/13/2021