Everything you need to know about perioral dermatitis

Heard of perioral dermatitis? We ask the experts to break down the symptoms, causes and treatment of this common inflammatory skin condition.

Has a rash or a host of tiny red bumps taken up residence around your mouth?

There is a chance it’s perioral dermatitis.

Since the COVID-19 pandemic, there has been discussion on how overzealous skincare product use both during and beyond lockdowns may have sparked an increase in the condition.

But product overuse is not the only factor in perioral dermatitis outbreaks.

Here the experts explain what you need to know about this inflammatory rash.

What is perioral dermatitis?

The name offers a clue: “peri” means “around” while “oral” refers to the mouth.

Dermatologist and Mohs proceduralist Dr Eleni Yiasemides, of SouthDerm clinic in Sydney, confirms “perioral dermatitis is a fairly common inflammatory skin condition that usually appears around the mouth”.

However, Dr Yiasemides notes it is interchangeably referred to as “periorificial dermatitis”, which means it can appear around any orifices, including the nose, eye and chin area.

Signs and symptoms of perioral dermatitis

“Perioral dermatitis is characterised by multiple small, pimple-like bumps and scaly, rough pink or red skin,” Dr Yiasemides says.

“It can also sometimes peel or crack the skin.”

Studies note that perioral dermatitis is predominantly seen in women aged 20 to 45 and in children.

Dermatologist and UNSW Associate Professor Deshan Sebaratnam says the reason it affects these groups is unknown but likely “relates to a dysfunction of the epidermis or top layer of the skin”.

Assoc Prof Sebaratnam, of Dermatology North Sydney, adds that perioral dermatitis is not contagious – so there is no need to worry about “catching it” from someone who has it.

Is it perioral dermatitis, acne or something else?

Perioral dermatitis shares overlapping features with other common skin concerns and, therefore, it is frequently mistaken for conditions such as acne, rosacea or eczema, according to Dr Yiasemides.

The dermatologist notes that if symptoms of itchiness or discomfort are present, they are more likely associated with eczema, contact dermatitis, or a skin irritant or allergen.

To prevent following the wrong course of treatment, she suggests consulting a medical professional or dermatologist for an accurate diagnosis and treatment plan.

Causes of perioral dermatitis

Mystery surrounds what causes perioral dermatitis, and it “can sometimes happen without reason,” Assoc Prof Sebaratnam notes.

However, both experts agree there are some known triggers – a common one being steroid-based medication.

“Perioral dermatitis can be associated with long-term use of medications like topical corticosteroids or inhaled steroid medications,” Assoc Prof Sebaratnam says.

Other triggers include overuse of skincare products, thick and occlusive creams, make-up and some sunscreens.

Dr Yiasemides adds other potential causes could be “stress, hormonal fluctuation and seasonal outbreak” – or even be a combination of a few factors.

Recently, there have been questions around a potential link between poor gut health and perioral dermatitis, but both experts say this is so far unsubstantiated.

“There is no scientific evidence in the medical literature that supports the link between perioral dermatitis and gut health,” Assoc Prof Sebaratnam says.

How is perioral dermatitis treated?

The first step when trying to eliminate perioral dermatitis is to remove any likely triggers such as steroid medications, skincare products or make-up.

If this doesn’t clear the condition on its own, it is time to consult a medical professional to prescribe a course of anti-inflammatory treatments.

“These prescribed medicines will be either applied to the skin topically or given orally as tablets,” Assoc Prof Sebaratnam says, adding that the course of treatment is “about twelve weeks, which is the amount of time needed to dampen the inflammation.”

To support skin during the recovery phase, Dr Yiasemides says it is essential to strip back your skincare routine.

“Use only a very mild, gentle cleanser and very light, bland lotion; avoid all topical steroids, thick creams and, if you can, make-up,” she suggests.

Dr Yiasemides also strongly cautions against the temptation to use steroid creams to fix perioral dermatitis – even if they appear to offer temporary relief.

“These (steroid creams) are often ‘one step forward and two steps back’,” she says.

“Although they make the skin look and feel better in the short term, in the long term the rash will flare up with a vengeance once the steroid product is stopped.”

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Written by Sharon Hunt.