Perioral dermatitis: causes and care for a rash around the mouth

Perioral dermatitis is a rash of small red bumps around the mouth, and sometimes around the nose and eyes. It often starts or gets worse because of the very creams people use to calm it, especially steroid creams.

Quick answer: Perioral dermatitis is a common, harmless but stubborn facial rash. The first step is usually to stop steroid creams on the face (with your doctor's help) and strip your routine back to water, a very gentle cleanser and a plain moisturizer. A dermatologist can prescribe creams or antibiotic tablets. Expect a flare before it improves, and treatment over several weeks.

What does perioral dermatitis look like?

• Clusters of small red bumps, sometimes with tiny pus-filled spots or flaky, dry skin.
• Around the mouth, the sides of the nose and the chin, and sometimes around the eyes.
• Often a narrow band of clear skin right next to the lips.
• Burning, tightness or mild itch, more than pain.

Doctors also call it "periorificial dermatitis", because it can appear around the eyes and nostrils too. It is most common in women aged about 20 to 45, but it also affects children.

Perioral dermatitis vs acne, rosacea and eczema

Because these conditions look alike, it is worth getting a diagnosis. Most dermatologists can tell by looking at the skin.

What causes perioral dermatitis?

The exact cause isn't fully known, but research points most strongly to steroid creams on the face. Common triggers include:

• Steroid creams on the face, including mild ones bought without a prescription.
• Steroid inhalers and nasal sprays.
• Heavy, occlusive creams (rich layers that seal the skin) and using many products at once.
• Some cosmetics and sunscreens.
• Toothpaste, including fluoride toothpaste, in some people.
• Hormonal changes, such as birth control pills, pregnancy or the days before a period.
• Heat, wind and sun can make it feel worse.

What is "zero therapy"?

"Zero therapy" means stopping almost all products on the rash. Dermatologists often suggest:

1. Stop makeup, face creams, serums and scrubs on the area.
2. Wash with lukewarm water, or a very gentle, fragrance-free cleanser.
3. If skin feels dry, use a plain, additive-free moisturizer, and avoid heavy creams.
4. A light gel or liquid sunscreen is usually fine.
5. When the rash has settled, bring back products one at a time, a week or two apart.

For mild cases this alone can help, though it is slow. Products with fragrance and rich occlusive layers are among the first to cut.

How doctors treat perioral dermatitis

If the rash is moderate, lasts a long time or affects the eyes, a dermatologist may prescribe:

• Prescription creams or gels, such as topical antibiotics or non-steroid anti-inflammatory creams. Your doctor may also discuss azelaic acid, although studies on it are mixed.
• Antibiotic tablets taken for several weeks for widespread or stubborn cases. Doctors choose different antibiotics for children and for pregnant women.

A large review found that the research behind most treatments is of low quality, so doctors often try one option and adjust. Treatment usually lasts several weeks, and stopping too early can bring the rash back.

Why it often flares after stopping steroid creams

If you have used a steroid cream on your face, stopping it often causes a rebound flare, and the rash can look worse for a while. Do not restart the steroid to calm it. Your dermatologist may suggest tapering it slowly or switching to a non-steroid cream to make this phase easier.

Skincare while you heal

• Keep your routine very short and fragrance-free.
• Skip exfoliating acids, retinoids, scrubs and face oils until the rash clears.
• Avoid slugging and thick balms around the mouth.
• If you have sensitive skin that reacts easily, keep a list of products you reintroduce.
• Choose a simple, light moisturizer if you need one.

How long does perioral dermatitis take to go away?

With treatment, many people see a clear improvement over about one to two months. Without treatment it can last for months. It can come back, especially if steroid creams or heavy products are used again, and the same treatment can usually be repeated.

When to see a dermatologist

• For a diagnosis, since it can look like acne, rosacea or eczema.
• Before stopping a steroid cream you have used on your face for a long time.
• If the rash spreads near your eyes, or your eyes feel irritated.
• If a child has the rash.
• If it hasn't improved after a few weeks of zero therapy.

FAQ

Is perioral dermatitis contagious?

No, you cannot catch it from someone or pass it on.

Can I wear makeup with perioral dermatitis?

It's best to stop while the rash is active, then reintroduce products slowly.

Is perioral dermatitis the same as rosacea?

They are different conditions, but they can look similar and some treatments overlap. People with redness-prone skin should ask a dermatologist to check.

Can children get perioral dermatitis?

Yes. It is seen in young children too, sometimes after steroid creams or inhalers, or thick creams and sunscreens on the face. A doctor should check a child's rash, because the treatments used for children differ from those for adults.

Will it come back?

It can, especially if steroid creams or heavy products are used again. Keeping your routine short and simple helps lower the chance.

Sources

• Periorificial dermatitis (DermNet)
• Perioral dermatitis: treatment, symptoms and causes (Cleveland Clinic)
• Pharmacological interventions for periorificial (perioral) dermatitis in children and adults: a systematic review (PubMed)
• Perioral dermatitis: diagnosis, proposed etiologies, and management (PubMed)