Perioral dermatitis: treatment, causes and what to avoid

PCDS advises stopping any topical steroids, emollients and cosmetics on the affected skin, and avoiding washing the face with soap or any product that lathers. If you use a topical steroid for a skin condition elsewhere, wash your hands afterwards so that you do not accidentally transfer any to your face. For sunscreen it suggests a liquid or gel, which is less greasy, washed off once you are out of the sun. Once things improve you may be able to thinly apply a light oil-free moisturiser if the skin becomes too dry.

Patient.info's professional article adds that substances that dilate skin blood vessels, such as alcohol and spicy food, may be best avoided. If you have been using a topical steroid on your face for a long time, do not simply guess: Patient.info says that in cases of preceding long-term misuse, gradual withdrawal with a low-strength hydrocortisone cream can be tried, and that initial worsening may occur, so a GP or pharmacist can help you plan it.

PCDS says to make an appointment at your GP surgery if skin is not improving with these measures. Treatment options may include antibiotic tablets, often for an initial period of 6 weeks, or topical treatments if the spots are less troublesome. Patient.info describes a topical antibiotic such as clindamycin or erythromycin for milder cases and otherwise a systemic antibiotic for 4 to 6 weeks, giving doxycycline or lymecycline as examples.

For resistant or granulomatous forms, the professional article says oral isotretinoin may be considered and that pimecrolimus cream is an option when other treatments have failed. These are decisions for a clinician, often a dermatologist, rather than something to start independently.

PCDS says certain creams, gels or ointments can make perioral dermatitis worse: topical steroids, whether applied deliberately to the face or inadvertently; emollient creams (moisturisers); and cosmetic creams and sunscreens. Nasal steroid sprays, steroid inhalers for conditions such as asthma, and steroid tablets may also worsen it.

Patient.info adds further associations reported in the professional literature: fluoridated toothpaste, high-factor sun protection creams in children, and physical factors such as ultraviolet light, heat and wind. It notes that hormonal factors are suspected because of premenstrual deterioration in some people and that oral contraceptives may be a factor. It also says no clear correlation exists between the strength of a steroid or length of use and the risk, and that an underlying cause cannot be detected in all patients.

Perioral dermatitis is a rash of small, inflamed spots that appear around the mouth. The name can mislead: PCDS explains that perioral means around the mouth and that, although dermatitis is a word used for eczema, this condition is not eczema. The exact cause is unknown, according to PCDS, although a number of things are known to make it worse.

It is usually a nuisance rather than a danger, but the facial location and the way it can persist for months make it distressing for many people. Patient.info notes that emotional effects and lifestyle restrictions can develop because of the visible and sometimes long-lasting nature of the rash.

PCDS describes many similar small red spots, some with a white head. They mainly occur around the mouth, can spread to the area around the eyes (periocular dermatitis) and can occasionally affect several areas of the face, though not the cheeks or forehead. The skin at the bottom of the nose can look pink-red. PCDS says it can be itchy, while the professional Patient.info article says there is often a burning and tight sensation, with itching being rare.

The Patient.info article also points out useful distinctions from other conditions: a pale area next to the border of the mouth, sparing the lip margins, is characteristic, and facial flushing and visible small blood vessels are not features of perioral dermatitis, whereas they are seen in rosacea. Rosacea, acne and contact dermatitis are listed as the main alternatives a clinician considers.

Patient.info lists rosacea, acne vulgaris and contact dermatitis as the conditions a clinician considers alongside perioral dermatitis. It gives a few features that help tell perioral dermatitis apart. A diagnosis is a clinical decision, and the table is only a guide to what the source says.

None of the sources read describe perioral dermatitis as an infection that passes from person to person. PCDS describes it as a skin rash with an unknown exact cause and a number of things that make it worse, such as certain creams. Patient.info notes that candidiasis has been suggested as a provoking factor, but it lists this alongside other possible influences and does not say the rash itself is caught from others.

PCDS describes antibiotic tablet courses often lasting an initial 6 weeks, so improvement is gradual rather than immediate. Patient.info notes that an initial worsening of symptoms may occur with treatment, especially if topical steroids are withdrawn, and that the disease can have a chronic course.

Patient.info says scarring may be a problem with the lupoid form of perioral dermatitis, a severe variant with yellowish granulomatous infiltrates, and that emotional complications and lifestyle restrictions can develop because of the visible nature of the rash. Because the sources link flare-ups to steroid creams and cosmetics, keeping a note of what you were using when it flared is a practical step to share with your clinician. That is a common-sense suggestion rather than something the sources specify.

PCDS says to make an appointment at your GP surgery if your skin is not improving despite stopping the likely triggers. Other skin conditions can look similar, so a clinician can confirm the diagnosis. Patient.info lists rosacea, acne vulgaris and contact dermatitis as the main alternatives a clinician considers.

PCDS says the main reason for referring to a specialist is if the diagnosis is unclear. The specialist will be either a dermatologist or a GPwER/GPwSI (a GP who has been trained in relevant areas of dermatology), and the appointment may be face to face or a video call (teledermatology).

Perioral dermatitis is usually assessed first in primary care, where a GP can advise on stopping triggers and prescribe antibiotic tablets or creams. PCDS says referral to a dermatologist, or to a GP with extra training in dermatology, is mainly for when the diagnosis is unclear. Appointments may be face to face or by video (teledermatology).

Some people choose to see a dermatologist privately. If you do, it helps to bring a list of every cream, cosmetic, sunscreen, nasal spray and inhaler you use, because those are the things the sources link to flare-ups.