Perioral dermatitis: Symptoms, treatment, and prevention - Harvard Health

If you are experiencing flaky red rashes and inflamed bumps around your mouth, these symptoms may be more than just dry winter skin and pimples. You may have a skin condition called perioral dermatitis.

What is perioral dermatitis?

Perioral dermatitis (POD), also known as periorificial dermatitis, is a common skin disorder that can occur around the mouth, nose, and eyes. POD is different from acne, rosacea, eczema, and dry skin, although the conditions can share overlapping features.

Perioral dermatitis symptoms

Perioral dermatitis typically appears as clusters of small red bumps and/or dry red rashes on the face. In people with darker skin, the bumps may appear flesh-colored.

As the name suggests, these symptoms most commonly appear around the mouth, but do not extend onto the lips. POD may also be seen on the chin, around the nose and eyes, and very rarely on the ears, neck, and scalp. The skin eruption may be accompanied by burning or itch.

In children, the condition may appear as small, firm, yellow or brown bumps.

Causes of perioral dermatitis and who is at risk

The cause of perioral dermatitis is unknown. Certain factors such as skin irritants, which cause breakdown of the top layer of the skin, may contribute. People with a history of eczema, which interferes with the barrier function of the skin, are at increased risk.

POD occurs in all ages, sexes, and ethnicities, but is more common in women ages 16 to 45. It is also more common in people who use topical (applied to the skin), oral, or inhaled steroid medications. Other factors that may contribute to POD flares include:

• fluoride toothpaste
• heavy skin moisturizers and cosmetic products, or those that are occlusive (create a barrier on the skin that locks in moisture)
• oral contraceptives
• hormone fluctuations in women
• the presence of certain fungi, bacteria, or mites on the skin
• problems with the balance of bacteria on your skin, or with your immune system.

Is it contagious?

Perioral dermatitis is an inflammatory skin condition. It is not contagious.

Perioral dermatitis treatment

Perioral dermatitis can be treated with both over-the-counter products and prescriptions written by your doctor.

The first step of treatment is to stop using any facial products or cosmetics that are irritating, heavy, or occlusive on your skin. Topical steroids, both prescription and over-the-counter hydrocortisone, are not recommended. While steroid creams may provide an initial improvement, the rash will flare and worsen once discontinued.

In some cases, POD resolves on its own without any treatment necessary.

Over-the-counter treatments

If you have perioral dermatitis, try to adhere to a minimal therapy approach to your over-the-counter skin care regimen. This means avoiding potential skin irritants and cosmetics. Stick to fragrance-free, exfoliant-free, gentle face wash and moisturizer. Once the condition clears, you can slowly start to reintroduce your skin care products.

In addition to minimal therapy, you can try over-the-counter remedies that may help clear this condition more quickly, such as:

• azelaic acid gel
• sulfur-based topical skin care products.

Medications

If your perioral dermatitis is not improving with over-the-counter techniques, see a dermatologist or other trained clinician. He or she may prescribe topical or oral medication to treat your POD.

A doctor will typically prescribe topical medications in the form of lotions, creams, gels, or face cleansers for initial treatment. For more severe cases, or those that do not respond to topical therapies, your doctor may prescribe oral medications.

Examples of medications your dermatologist may prescribe include:

• topical antibiotics including clindamycin, erythromycin, and metronidazole
• sulfur-based creams or cleansers
• azelaic acid cream or gel
• nonsteroid, anti-inflammatory topical treatments such as pimecrolimus cream and tacrolimus ointment
• oral antibiotics including doxycycline, minocycline, and erythromycin.

Preventing perioral dermatitis

The best way to prevent perioral dermatitis is to avoid using skin care products and cosmetics that feel harsh or irritating to your skin. In addition:

• Minimize or avoid use of topical steroids including hydrocortisone on your face. If you have a medical condition that requires the use of prescription steroid medications, discuss this with your doctor.
• Stick to a simple skin care regimen that includes a gentle face cleanser and a moisturizing lotion.
• Gradually introduce new skin care products one at a time.

Finally, you can schedule a skin evaluation with a board-certified dermatologist or other trained clinician to discuss the best products and regimen for your skin type.

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