Understanding and Treating Perioral Dermatitis

PUBLISHED ON 2023/11/21 at 1:49 PM

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Understanding Perioral dermatitis

Have you ever woken up to a pesky, uncomfortable rash around your mouth and wondered, “What on earth is this?” You’re not alone. This is a common tale for those dealing with perioral dermatitis, a skin condition that’s as tricky to understand as it is to pronounce.

In this post, we’re peeling back the layers of perioral dermatitis. Think of it as a chat with a friend who’s been through it all and is here to share the journey with you. We’ll explore what causes these irritating breakouts, how they differ from other skin issues, and most importantly, what you can do about them.

No medical mumbo jumbo, just simple, clear information. Because we believe that managing your skin shouldn’t feel like a battle. We’ve researched the topic extensively and have dermatologist-approved recommendations for you. Also, we drew on our years of experience to give you the best answers on perioral dermatitis.

So, grab a cup of your favorite drink, and let’s dive into the world of perioral dermatitis together – one step at a time.

What Really Is Perioral Dermatitis?

Perioral dermatitis, also known as periorificial dermatitis, is a facial rash that tends to occur around the mouth and sometimes the eyes, nose, or forehead. It is a facial dermatitis that tends to occur in young women and children.

The rash is typically characterized by small red papules (bumps) and pustules (pimples) that may be surrounded by red or pink skin. It can be itchy or tender, and in some cases, it may resemble other skin conditions like acne or rosacea.

How Can You Distinguish Between PD and Other Skin Conditions?

Perioral dermatitis, acne, and eczema are distinct skin conditions with different causes, symptoms, and treatments. Here are some key differences between them:

What Is The Location of the Rash?

  • Perioral Dermatitis: Typically occurs around your mouth, but can also affect the eyes, nose, or forehead. It presents as small red papules and pustules.
  • Acne: Commonly occurs on the face, back, chest, and shoulders. Blackheads, whiteheads, and various types of pimples characterize it.
  • Eczema (Dermatitis): Can occur anywhere on your body and often involves red, itchy, and inflamed skin. Eczema may have a different appearance, such as dry, scaly patches.

What are the Underlying Factors?

  • Periorificial Dermatitis:

    The exact cause is not well understood, but it may be associated with the use of topical steroids on the face, hormonal factors, or certain skincare products.

  • Acne:

    Caused by a combination of factors, including excess oil production, clogged hair follicles, bacteria (Propionibacterium acnes), and hormonal changes.

  • Eczema:

    Often related to a combination of genetic and environmental factors. It may be triggered or exacerbated by irritants, allergens, or stress.

What Are The Lesion Characteristics?

  • Perioral Dermatitis: Small red papules and pustules with surrounding red or pink skin. It may be itchy or tender.
  • Acne: Various types of lesions, including blackheads, whiteheads, papules, pustules, nodules, and cysts.
  • Eczema: Dry, scaly patches of skin, redness, and itching. It may also involve oozing or crusting in more severe cases.

What Treatment You Can Approach?

  • Perioral Dermatitis: Treatment often involves discontinuing the use of topical steroids, avoiding potential triggers, and using antibiotics (topical or oral).
  • Acne: Treatment options include topical retinoids, antibiotics, benzoyl peroxide, and oral medications like antibiotics, hormonal treatments, or isotretinoin.
  • Eczema: Management involves moisturizers, topical corticosteroids, and other anti-inflammatory medications. Identifying and avoiding triggers is also crucial.

It’s important to note that these conditions can sometimes have overlapping features, and a healthcare professional, such as a dermatologist, can provide an accurate diagnosis based on a thorough examination of the skin and medical history.

What Are The Causes of PD?

The exact cause of PD is not well understood, but several factors may contribute to its development. Some potential causes include:

Topical Steroid Use:

  • PD is often associated with the use of topical steroids on the face. These steroids may be present in creams, ointments, or other skincare products. Discontinuing the use of these steroids is a key step in the management of PD.

Hormonal Factors:

  • Hormonal fluctuations, especially in women, may play a role in the development of periorificial dermatitis. It often occurs in young women and can be associated with changes in hormonal levels.

Fluorinated Toothpaste:

  • Some toothpaste and dental products contain fluoride, which has been implicated as a trigger for PD in some cases. Changing toothpaste to one without fluoride may be recommended in such instances.

Skin Care Products:

  • The use of certain skincare products, particularly those containing heavy oils or comedogenic ingredients, may contribute to the development of perioral or facial dermatitis. Abrasive or irritating products can also be a factor.

Underlying Skin Conditions:

Individuals with a history of other skin conditions, such as rosacea or, Seborrheic Dermatitis may be more prone to PD.

Environmental Factors:

  • Environmental factors, such as exposure to extreme weather conditions, may exacerbate PD in some cases.

What Are the Risk Factors You Should Avoid If You Have PD?

If you have perioral dermatitis, there are certain risk factors and triggers that you may want to avoid to help manage and prevent flare-ups. Here are some recommendations for you.

Using Topical Steroids:

  • Avoid the use of topical steroids on the affected area. They can exacerbate PD, and withdrawal from these medications is often a key part of treatment.

Stop Using Fluoride-containing Toothpaste:

  • Some cases of PD have been linked to fluoride in toothpaste. Consider using a fluoride-free toothpaste to see if it helps reduce symptoms.

Avoid Certain Skincare Products:

  • Be cautious with skincare and cosmetic products. Avoid heavy oils, comedogenic ingredients, and harsh or abrasive products on the affected area.

Avoid Hormonal Birth Control:

  • In some cases, hormonal changes can contribute to PD. If you are using hormonal birth control and suspect it may be a trigger, discuss alternative options with your healthcare provider.

Be Cautious of Environmental Factors:

  • Protect your skin from extreme weather conditions, such as harsh winds or excessive sun exposure, which can potentially aggravate PD.

Avoid Stress:

  • While stress is not a direct cause, it can exacerbate various skin issues, including PD. Managing stress through relaxation techniques or counseling may be beneficial.

Avoid Picking or Scratching:

  • Refrain from picking, squeezing, or scratching the affected area, as this can worsen the condition and potentially lead to scarring.

Pay Attention To Your Diet:

  • Some individuals report improvements by avoiding certain foods, such as spicy foods or those high in histamines. It may be worthwhile if you explore dietary changes in consultation with a healthcare provider.

How Can You Identify You Have Perioral Dermatitis?

The possible symptoms that can lead to the PD are as follows:

  1. Redness: The affected areas can appear red and inflamed.

  2. Bumps or Papules: Small, red, and raised bumps or papules may develop. These can sometimes be filled with pus.

  3. Burning or Itching Sensation: You may experience a burning or itching sensation in the affected areas.

  4. Flaky or Peeling Skin: The skin around your mouth may become flaky or start to peel.

  5. Pimple-like Lesions: The rash may resemble acne with pimple-like lesions.

  6. Papulopustular Rash: The rash often has a characteristic appearance with clusters of small, red bumps that may have a central pustule.

  7. Distribution around the Mouth and Eyes: PD typically spares the skin around the eyes but affects the areas around the mouth, sometimes extending to the cheeks and nose.

It’s important to note that PD can be mistaken for other skin conditions such as acne or rosacea. If you suspect you have PD or are experiencing persistent skin issues, it is advisable to consult a dermatologist for a proper diagnosis and appropriate treatment. 

How do Dermatologists Diagnose Perioral Dermatitis?

Diagnosing PD typically involves a combination of a thorough medical history, clinical examination, and sometimes additional tests. Here are the diagnostic methods commonly used by dermatologists for perioral dermatitis:

  1. Your Clinical Examination: Dermatologists will examine the affected areas of your skin, particularly around the mouth, nose, and eyes. Periorificial dermatitis often has a distinctive appearance with red papules and pustules.

  2. Asking Medical History: There are other relevant factors that are crucial for the diagnosis. They will ask you for information about the onset of symptoms, any recent use of topical steroid creams, or changes in skincare products.

  3. Doing Biopsy: In some cases, a dermatologist may recommend you a skin biopsy. A small sample of your skin is taken and examined under a microscope to confirm the diagnosis and rule out other skin issues.

  4. Elimination of Triggers: If topical steroid creams are suspected as a cause, the dermatologist may advise discontinuing their use. Improvement in symptoms after discontinuation can support the diagnosis of perioral dermatitis.

  5. Doing A Patch Test: If there is suspicion of contact dermatitis or an allergic reaction to a specific substance, patch testing may be conducted to identify potential allergens.

  6. Taking A Blood Test: In some cases, blood tests may be performed to rule out other potential causes or to assess overall health. But these are not typically specific to PD.

What Treatments You Should Try For PD?

The medical treatment of perioral dermatitis typically involves a combination of lifestyle changes, discontinuation of potential triggers, and, in some cases, medications prescribed by a dermatologist. Here are some general approaches for the effective treatment of PD:

  1. Discontinuation of Topical Steroids: If the use of steroid creams is identified as a trigger, the first step is to discontinue their use. However, this should be done under the guidance of a healthcare professional. Abruptly stopping steroids can sometimes lead to a flare-up.

  2. Using Topical Antibiotics: Dermatologists often prescribe topical or oral antibiotics to reduce inflammation and control bacterial overgrowth. Common topical medications include metronidazole, clindamycin, and tetracycline. 

  3. Topical Calcineurin Inhibitors: In some cases, dermatologists may recommend topical calcineurin inhibitors, such as tacrolimus or pimecrolimus, as an alternative to steroids.

  4. Incorporating A Gentle Skincare Routine: Use a mild, fragrance-free cleanser and moisturizer. Avoid using harsh products or excessive cleansing, as this can exacerbate your symptoms.

  5. Implying Sun Protection: Protect the affected areas from the sun using a broad-spectrum sunscreen with at least SPF 30. Sun exposure can worsen your PD.

  6. Avoiding Triggers: Identify and avoid potential triggers such as spicy foods, toothpaste with fluoride, and certain cosmetics.

  7. Oral Contraceptives: For some women, hormonal factors may play a role. In such cases, oral contraceptives may be considered under the guidance of a healthcare provider.

  8. Probiotics: Some studies suggest that probiotics may be beneficial in managing perioral dermatitis by promoting a healthy balance of bacteria on the skin and in the gut.

What Natural Remedies You Can Use for PD?

You should cautiously approach home remedies for PD.  Also, consulting with a healthcare professional before trying alternative treatments is crucial. Some of the  natural remedies you can use for PD are:

What Steps You Can Take to Prevent Perioral Dermatitis?

While the exact cause of PD is not well understood, and individual responses to preventive measures may vary. There are some general recommendations that may help you reduce the risk of PD or prevent flare-ups. 

 Avoid Steroids:

Limit the use of steroids on the face, especially around the mouth, nose, and eyes. If prescribed, use them strictly according to your dermatologist.

Use Gentle Skincare Practices:

  • Use mild, fragrance-free cleansers, moisturizers, and facial creams on your face.
  • Avoid abrasive scrubs and harsh skincare products that may irritate the skin.
  • Choose your foundations wisely.

Choose Toothpaste Wisely:

  • Use fluoride-free toothpaste or consider switching to toothpaste without sodium lauryl sulfate (SLS), as SLS has been associated with perioral dermatitis in some cases.

Get Sun Protection:

Protect your face from the sun by using a broad-spectrum sunscreen with at least SPF 30. Sun exposure can trigger or worsen PD.

Identify and Avoid Triggers:

  • Pay attention to factors that may trigger or worsen your symptoms. This may include certain foods, cosmetics, or environmental factors. They may cause you skin irritation.

Stay Hydrated:

  • Maintain good skin hydration by drinking an adequate amount of water.

Consider Hormonal Factors:

  • For some individuals, hormonal factors may play a role. If relevant, discuss hormonal options with your healthcare provider.

Add Probiotics In Your Diet:

  • Consider incorporating probiotics into your diet to promote a healthy balance of bacteria on the skin and in the gut.

Regular Dermatological Check-ups:

  • Schedule regular check-ups with a dermatologist to monitor your skin health and discuss any concerns.

It’s important to note that these preventive measures are general recommendations, and their effectiveness may vary from person to person.

What’s The Relationship Between Skin Conditions and Mental Health?

Skin issues, including PD, can have a significant psychological impact on mental health. Visible skin issues can affect self-esteem, body image, and overall emotional well-being.

Coping with the psychological aspects of skin problems involves a combination of self-care, support from others, and professional assistance. Here are some ways to cope with the psychological impact of perioral dermatitis:

Seek Professional Support:

  • Consult with a dermatologist to address the physical symptoms of PD. They can provide effective treatment options to manage the condition.
  • If the psychological impact is substantial, consider consulting with a mental health professional, such as a psychologist or counselor, to discuss your feelings and develop coping strategies.

Educate Yourself:

  • Learn about PD to understand the condition better. Knowing the causes, triggers, and available treatments can empower you to manage the situation more effectively.

Open Communication:

  • Share your feelings and concerns with friends, family, or a support group. Talking about your experiences can provide emotional relief and foster understanding among those close to you.

Focus on Self-Compassion:

  • Practice self-compassion by acknowledging that having a skin issue does not define your worth or identity. Treat yourself with kindness and understanding.

Develop a Skincare Routine:

  • Establish a gentle skincare routine that supports the management of perioral dermatitis. This can contribute to a sense of control over the condition.

Explore Makeup Techniques:

  • If appropriate, explore makeup techniques to conceal or minimize the appearance of the rash. However, be cautious with makeup products to avoid exacerbating the condition. 

Set Realistic Expectations:

  • Understand that managing PD may take time. Set realistic expectations and be patient with the healing process.

Engage in Stress-Reduction Activities:

  • Practice stress-reduction techniques such as meditation, deep breathing, yoga, or other activities that promote relaxation. Stress can exacerbate skin conditions, so managing it is crucial.

Real Stories: Dealing With Perioral Dermatitis

In our journey to understand and conquer PD, real stories from individuals who’ve faced this skin condition head-on can be powerful sources of inspiration and guidance. Their experiences shed light on the challenges and triumphs that come with managing perioral dermatitis.

We are sharing the experience of Bachelor alum Kristina Schulman with you so that you can get inspiration for dealing with your skin issues. Here is what she says on the captions of her photos on Instagram,

“This morning I woke up feeling down, overwhelmed, sad, and defeated. For the past few days, I stayed quiet and off social media in hopes that I’ll reach [a] mental state where I can share my skin’s journey + progress—that progress hasn’t come… just yet.”⁣

Schulman modified her skincare approach by adjusting her makeup routine to eliminate potentially irritating products. She opted for an ultra-minimalist skincare routine and transitioned to hypoallergenic laundry detergent as part of her treatment process. She says,

“But here we are, still struggling with random flare-ups that hurt, itch, burn, feel very dry and tight⁣.”

This time I hope to be better prepared and offer some knowledge in return⁣,” she said.

“While I know I am not alone in this or with this condition (which is very tricky to treat since triggers are different for each individual),” Schulman wrote, “I hope we can create a community where we can openly share our journey and success stories.”

Some Frequently Asked Questions:

Now that we have understood the condition well, let’s delve into some FAQs that are mostly asked by the people to a dermatologist.

How long does it typically take to see improvements with treatment for perioral dermatitis?

The timeline for improvement in PD varies, but some individuals may notice improvement within a few weeks, while complete resolution may take several weeks to months. Consistency in following the prescribed treatment plan is crucial for optimal results. 

Is perioral dermatitis more common in certain age groups or demographics?

PD can occur in individuals of any age, but it is more commonly reported in women, particularly those between the ages of 16 and 45. However, men and children can also develop PD. 

Is perioral dermatitis a chronic condition, or can it be cured?

PD can be a persistent condition, but it is manageable with appropriate treatment. Many individuals experience significant improvement and long-term control with proper care and lifestyle adjustments. Regular follow-ups with a dermatologist are recommended for monitoring and adjusting the treatment plan as needed.


/ Final Verdict

We have come this far in exploring and understanding perioral dermatitis. In this blog post, we have covered almost every point you need to know about this condition.

In conclusion, PD is a dermatological challenge. While it can not not always easily cured, but can be effectively managed with the right approach. As we’ve explored its symptoms, triggers, and management strategies, one thing remains clear: each individual’s journey with perioral dermatitis is unique.

It’s crucial to consult with a dermatologist for a personalized diagnosis and treatment plan tailored to your specific needs.

With patience, consistency, and the support of both medical professionals and individuals who understand the journey, you can often lead to improved skin health and overall well-being.

Your skin is a reflection of your health, and with the right care, it can flourish. Let’s meet again with a healthy skin.

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