Perioral Dermatitis

What is perioral dermatitis?

Perioral dermatitis is a common facial rash of small red bumps and pus spots around the mouth. When it also involves the skin around the nose and eyes, the term periorificial dermatitis is sometimes used.

Who gets it?

It most often affects women aged 20 to 50, of all skin types, but men and children can also develop it.

What causes it?

Its exact cause is unknown, although a number of triggers are well established. The most important is the use of steroid creams or ointments on the face, including mild over-the-counter hydrocortisone. Steroid creams may seem to improve the rash at first, but it then returns, often worse, when they are stopped. Steroids used in other ways, such as nasal sprays, inhalers and tablets, can also be linked.

In some people, heavy face creams, moisturisers, foundations and other cosmetics, physical sunscreens, some toothpastes and hormonal changes may also contribute.

Is it hereditary or contagious?

Perioral dermatitis is not hereditary and is not contagious.

What does it look and feel like?

The rash consists of small red or skin-coloured bumps, sometimes with tiny pus spots or fine scaling, around the mouth, the creases beside the nose, the chin and sometimes around the eyes. It does not usually affect the cheeks or forehead. A characteristic feature is a narrow band of normal skin just around the edge of the lips. On brown and black skin, the bumps may be skin-coloured or darker and may be more noticeable as texture than colour.

The skin can feel dry, tight, sore, burning or itchy, and products that were previously tolerated may start to sting.

How is it diagnosed?

Perioral dermatitis is diagnosed from its appearance and history, including questions about creams, cosmetics and steroid use. It can look similar to acne, rosacea, seborrhoeic dermatitis and contact dermatitis. Tests are not usually needed.

What are the treatment options?

Dr Mounsey will confirm the diagnosis and identify likely triggers, especially steroid creams or heavy cosmetics. Treatment usually begins with stopping these products and switching to a very simple skin care routine, which on its own can help a great deal. Topical treatments such as metronidazole, azelaic acid or erythromycin can be used, and a course of a tetracycline antibiotic tablet, such as lymecycline or doxycycline, is often effective for more extensive cases. If steroid creams have been used for a long time, he will advise on stopping them safely.

What is the outlook?

Perioral dermatitis usually settles completely, although this can take several weeks to a few months, and without treatment it can persist for months or years. If steroid creams have been used, the rash commonly flares for a period after stopping them before it improves. Once facial steroids are stopped, it usually stays clear, although it can come back if triggers are reintroduced.

More information

British Association of Dermatologists patient leaflet: https://www.bad.org.uk/pils/peri-oral-dermatitis

This page gives general information only and is not a substitute for a consultation. Everyone's skin is different, and what is right for you will depend on your own circumstances. If you are worried about a skin problem, please book an appointment with Dr Mounsey or speak to your GP. If you have a mole or skin lesion that is changing, bleeding or growing quickly, please seek medical advice promptly.