Perioral dermatitis is a skin condition that causes a rash around the mouth. Perioral dermatitis may also occur around the eyes, nose, or genitals, but this is much less common. Treatments may include certain creams, lotions, or gels.

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Dermatitis refers to an inflammation of the skin, while perioral means around the mouth.

Perioral dermatitis is most common in females between the ages of 20 and 45 years. Older adults, males, and children can also have the condition, but it happens less frequently.

Perioral dermatitis belongs to the broader category of periorificial dermatitis, which can affect the skin predominantly around the eyes, the nostrils, the mouth, and occasionally the genitals.

However, when medical professionals discuss the condition affecting specifically the skin around the mouth, they use the term perioral dermatitis.

In most cases, perioral dermatitis affects young adults and adult females up to the age of 45. But when it affects children, health experts call it childhood perioral dermatitis.

Lupoid perioral dermatitis is a more severe version that results in a person developing denser groupings of bumps that can be red and brown on both light and darker skin tones.

Another related type of condition is granulomatous periorificial dermatitis. While it primarily occurs in children with darker skin tones, it can also present in children with light skin tones. It usually appears as flesh-colored, yellow-brown papules.

Perioral dermatitis is a rash that develops around the mouth and tends to be bumpy or scaly.

These bumps generally do not affect the skin right next to the mouth but appear a short distance away from the lips. They may also form a ring around the mouth.

Sometimes the rash can appear around the nose or eyes. It can occasionally appear around the genitals too, but this is rare.

What does it look and feel like?

Some people with perioral dermatitis may only get a few bumps, and their rash may not be very discernible. Others may have many lumps forming a noticeable rash.

The bumps may be skin colored or hyperpigmented and may appear red or pink in people with fair skin. Although they might resemble pimples, the bumps are not the same as acne. The rash may look inflamed, with the underlying and surrounding skin appearing red, pink, or flesh toned.

The rash may be itchy or non-itchy, but it does not usually hurt. Some people with perioral dermatitis may feel tightness or mild burning in the affected skin, which may be dry or flaky.

Granulomatous periorificial dermatitis is more common in darker-skinned people, who may experience less evident skin flushing and color changes. This condition has associations with burning, so individuals with darker skin may experience this symptom more frequently.

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Perioral dermatitis is a common facial skin problem.
Photo by DermNet New Zealand
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It presents as tiny red papules around the mouth and chin.
Photo by DermNet New Zealand
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The condition is commonly treated with facial ointments and creams.
Photo by DermNet New Zealand
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The skin is usually dry and itchy, with the papules presenting in clusters.
Miroslav Lukic/Shutterstock
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The condition can be caused by many things, including creams, soaps, and other external exposures.
© 2021, Diehl et al/NCBI
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Healing time varies for each individual but usually takes 2–4 weeks.
The Korean Dermatological Association and The Korean Society for Investigative Dermatology/NBCI

There is no underlying condition that causes perioral dermatitis, and it is not contagious. Although the exact cause is unknown, researchers think it may relate to the use of topical corticosteroids.

Topical corticosteroids are steroid ointments, creams, or gels that people use to treat skin conditions. However, individuals should only ever use topical corticosteroids as a short-term treatment, and most of them are not suitable for applying on the face. Sometimes, a person uses corticosteroids for longer than they should or use them on their face. This can result in skin damage.

A 2021 study showed that topical corticosteroids may have a link to a variety of skin conditions, including perioral dermatitis. Research from 2017 that explored the effects of the misuse of topical corticosteroids on facial skin also showed that perioral dermatitis was one of the adverse effects.

Additional possible causes of perioral dermatitis may include:

  • a problem with the skin’s protective barrier
  • a change in the bacteria on the skin
  • bacteria getting into the hair follicles
  • an allergic reaction
  • irritation resulting from a skin care product or fluorinated toothpaste
  • hormonal changes
  • strong winds
  • UV light
  • in children:
  • chewing gum
  • inhaling nasal steroids

More research is necessary to understand the exact causes of perioral dermatitis, but using heavily-scented toiletries or skin care products or wearing heavy makeup can trigger the condition.

Other possible risk factors can include young age, being female, hormonal imbalance, topical steroid use, and a history of allergies.

Symptomatically, periorificial dermatitis and its subcondition perioral dermatitis can appear quite similar to rosacea. Both cause red bumps, which may also appear yellowish-brown on darker skin colors, around the nose, mouth, and central area of the face, as well as scaling or peeling skin. Both conditions can also cause a sensation of burning.

However, the causes of the conditions are different. Rosacea is a chronic inflammatory condition. Its exact cause is unknown, but experts believe it has links to genetics, immune reaction, microorganisms, environmental factors, and neurovascular dysregulation.

People with rosacea often have more prominent blood vessels, which can lead to flushing easily. In contrast, perioral dermatitis is a rash that occurs primarily due to using topical corticosteroids, cosmetics, skin care products, fluorinated toothpaste, or other oral care products.

However, because of the similarities in symptoms, some researchers consider periorificial and perioral dermatitis a variant of rosacea.

As topical corticosteroids seem to be a primary risk factor for perioral dermatitis, it is essential to stop using them on the skin. This includes hydrocortisone.

If a doctor has prescribed corticosteroids, it is best to explore alternatives, as continuing to use them could cause the rash to worsen.

When a person stops using corticosteroids, their rash may worsen before it improves. A dermatologist may offer someone specific medications to help ease inflammation during this time.

Medical treatments for perioral dermatitis

The first medications a doctor may prescribe include:

It is important to consult a dermatologist if the rash does not get better on its own. The dermatologist may also prescribe oral or topical antibiotics or a cream that suppresses the immune response.

Natural treatments for perioral dermatitis

The following home remedies and lifestyle changes may help manage symptoms:

  • avoiding topical steroids
  • washing the face with warm water alone
  • using fragrance-free skin care products
  • avoiding the sun
  • avoiding fluorinated toothpaste

A 2018 study notes that coconut oil is a safe and effective skin moisturizer. Research suggests that it can benefit the skin by:

  • reducing inflammation
  • fighting bacteria
  • promoting wound healing
  • repairing the skin barrier

Due to these properties, coconut oil may help perioral dermatitis. However, some people may find that it can clog their skin pores. Researchers also need to carry out more studies into its effectiveness as a treatment for this skin condition.

Are there any side effects or complications of treatment?

Without treatment, a person can develop significant facial scarring from perioral dermatitis. This is more likely to occur if they have the more severe lupoid form of the condition.

The medications that a doctor may prescribe to treat the conditions can potentially cause skin irritation or an allergic reaction. A severe reaction can include anaphylaxis, a life threatening condition.

They may also cause skin dryness, burning, itching, or hypopigmentation. Using the topical drug Metronidazole may increase the risk of cancer and antibiotic resistance, so a person should use it only under guidance from a doctor.

Is there a perioral dermatitis cure?

There is no cure for perioral dermatitis, but many home remedies that can help relieve perioral dermatitis may also help prevent it.

First, people should only use topical steroids as a doctor advises. A person should limit using heavy makeup and fluorinated oral care products and choose fragrance-free, oral care, soap, and other skin care products suitable for sensitive skin.

Avoiding the sun and strong winds may also promote skin health.

If someone has perioral dermatitis that does not go away when they stop using topical steroids, they should speak with their doctor.

They may receive a referral to consult a dermatologist, a specialist in skin conditions. They can recommend the best course of treatment. And if a person has Medicare, they likely will not need a referral in most cases.

Some private health insurance companies, and especially Health Maintenance Organization plans, may require a referral or prior authorization before the visit.

How to prepare

A doctor will usually be able to diagnose perioral dermatitis according to the symptoms. They may ask a person questions about their lifestyle to determine the cause and differentiate the diagnosis from rosacea.

They will likely ask if an individual has been using corticosteroids or any fragrance- or fluoride-based products. A person may wish to bring information on their skin and oral care routine and any medications they are taking.

Medication side effects

If a person is already taking medications for perioral dermatitis, and their symptoms do not improve or get worse, they may be reacting to the medication. They should revisit their dermatologist for another evaluation to see if a change in treatment is necessary.

If a person experiences symptoms of a serious allergy or anaphylaxis after using topical medications, they should call 911 and get medical treatment immediately as this is a life threatening condition.

Anaphylaxis: Symptoms and what to do

Anaphylaxis is a severe allergic reaction that can be life threatening. The symptoms develop suddenly and include:

  • hives
  • swelling of the face or mouth
  • wheezing
  • fast, shallow breathing
  • a fast heart rate
  • clammy skin
  • anxiety or confusion
  • dizziness
  • vomiting
  • blue or white lips
  • fainting or loss of consciousness

If someone has these symptoms:

  1. Check whether they are carrying an epinephrine pen. If they are, follow the instructions on the side of the pen to use it.
  2. Dial 911 or the number of the nearest emergency department.
  3. Lay the person down from a standing position. If they have vomited, turn them onto their side.
  4. Stay with them until the emergency services arrive.

Some people may need more than one epinephrine injection. If the symptoms do not improve in 5–15 minutes, or they come back, use a second pen if the person has one.

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Perioral dermatitis often clears up on its own a few weeks after a person stops using topical steroids, but medical treatment may still be necessary. Using fragrance-free products helps avoid irritating the skin while it heals.

As a doctor examines the healing skin, they should begin to see less inflammation and decreased redness, skin bumps, and scaling. Other symptoms should also gradually decrease.

This skin condition may flare up if a person starts using topical steroids again. Flares can also occur with other triggering agents, such as fluorinated toothpaste or heavy, scented cosmetics. It is best to discuss alternative options with a doctor.