Perioral Dermatitis

What is perioral dermatitis?

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Perioral dermatitis is a type of skin rash that appears around the mouth. The rash is often bumpy or scaly and has a red or brown tinge, depending on the affected person’s skin tone. Perioral dermatitis can contain fluid, and some people may experience itching or burning. In some extreme cases, the rash may extend close to the nose and eyes.

In many cases, perioral dermatitis is chronic. This means patients experience periods of relapse and remission. However, working with a doctor to identify potential triggers, as well as effective treatments, can significantly improve symptoms. This condition is not dangerous, but its visibility on the face can cause distress to those affected.

If you suspect you have perioral dermatitis and want better control over recurring rashes, schedule an appointment with a dermatologist. They will be able to provide a diagnosis and prescribe a treatment regimen.

What causes perioral dermatitis?

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Doctors are unsure of the exact cause of perioral dermatitis. Evidence points to a connection with long-term use of topical steroids. These steroids are often prescribed to treat a separate condition, but with continuing use, they can cause their own side effects.

Additionally, inhaled steroids, like nasal sprays and certain asthma medications, can cause perioral dermatitis. Using thick sunscreen and heavy moisturizers may also cause this type of dermatitis. People who use skin creams that contain a paraffin or petroleum jelly base may cause or exacerbate this condition.

Using certain beauty products can also cause perioral dermatitis. Sodium lauryl sulfate (SLS) is a common ingredient in hair, makeup, and beauty products. This surfactant is known to cause skin irritation, which can take the form of perioral dermatitis.

The list of perioral dermatitis triggers is long and unique to each person. However, some triggers are more widespread than others. Consider whether any of these triggers may be the cause of your rash:

  • Previous fungal or bacterial infections
  • Use of birth control pills
  • Using steroid creams on the face
  • Using makeup on the affected area
  • Constant drooling during sleep and while awake
  • Using fluoridated toothpaste

If you’re not sure what may be triggering your perioral dermatitis, make an appointment with a dermatologist or allergist.

What are perioral dermatitis risk factors?

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Perioral dermatitis can occur in any person, regardless of sex, ethnicity, and age. However, there are a number of characteristics that come with a greater chance of developing this rash. These risk factors include:

  • Having a history of allergies, especially to ingredients in common topical skincare products
  • Having a history of hormonal imbalances or hormonal acne
  • Long-term use of topical steroid creams or ointments, particularly on the face
  • People who menstruate are more likely to develop perioral dermatitis than those who don’t
  • Middle-aged and young adults are more likely to develop this rash

People who use topical steroids and heavy facial products are usually at the greatest risk for developing perioral dermatitis.

What are the symptoms of perioral dermatitis?

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Perioral dermatitis symptoms appear as a rash. This rash begins around the mouth, but it can extend to the nose and eyes. Some people also develop perioral dermatitis around their genitals. While this condition is the same rash, it is often referred to as periorificial dermatitis.

A perioral dermatitis rash can look like many raised bumps clustered together. The bumps may be smooth or scaly. Color can range from red to dark brown, depending on the affected person’s skin tone. Perioral dermatitis is most readily identified by its location on the body – it almost always appears around the mouth.

Some people experience itching or burning at the rash site. This is especially true if the bumps become sores, which can leak fluid. Additionally, perioral dermatitis is typically chronic. This means that people who have had the rash before are prone to relapse. Instances of the rash often last a couple of weeks, but in extreme cases, it can last for several months.

Perioral dermatitis is not contagious, but if symptoms are uncomfortable, consult a dermatologist. They will be able to prescribe treatment to help alleviate symptoms.

How is perioral dermatitis diagnosed?

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If you or your primary care physician suspects perioral dermatitis, you will schedule an appointment with a dermatologist. In most cases, the doctor will provide a diagnosis after a thorough visual examination and medical history evaluation.

In some cases, a doctor may perform a skin biopsy or skin culture test. This can help to rule out possible infection. A dermatologist may refer you to an allergist if the rash appears to have a specific trigger.

There are a number of skin conditions that resemble perioral dermatitis. The doctor will need to rule out the following before providing a diagnosis:

  • Rosacea: Rosacea appears as inflammatory pustules and papules. It is often concentrated in the center of the face. Some doctors see perioral dermatitis as a rosacea variant, as they respond well to the same therapies.
  • Acne vulgaris: This is among the most common types of acne. It can appear as papules, pustules, comedones, and cysts. Concentration on the face is the primary distinguishing factor between acne vulgaris and perioral dermatitis.
  • Contact dermatitis: This type of dermatitis occurs when the skin comes in contact with an allergen. It may resemble perioral dermatitis but will resolve once the allergen is removed.
  • Seborrheic dermatitis: This type of dermatitis can look similar, but patches are often red, scaly, and rarely raised.

Regardless of which skin condition may be causing your rash, schedule a visit with a dermatologist. They can help you manage symptoms and prevent the rash from recurring.

What are treatments for perioral dermatitis?

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In some cases, perioral dermatitis may clear on its own. However, because of its location, many people seek out medical intervention to help clear it faster. When you see a doctor for perioral dermatitis, they will likely recommend one of the following treatments:

  • Prescribed topical antibiotic: Perioral dermatitis will often clear with a regimen of tetracycline, doxycycline, minocycline, isotretinoin, or erythromycin. In severe cases, the doctor may recommend an oral antibiotic.
  • Halt corticosteroid use: If you are currently using a topical steroid, the doctor will likely recommend you suspend use while the rash clears. However, the dermatologist will consult with your primary care physician before discontinuing certain medications.
  • Topical immunosuppressants: Creams and ointments, like Protopic and Elidel, can reduce the appearance of a perioral dermatitis rash.
  • Lifestyle changes: You will work with your doctor to identify potential triggers for perioral dermatitis. Understanding these triggers can lead to lifestyle changes. This can include avoiding spicy or salty foods, reducing makeup and cosmetic use, frequently washing pillows and towels, and getting rid of harsh skin products.

Perioral dermatitis healing times vary by person. For some, the rash may clear within a week of beginning treatment. For others, the rash may take months to heal. Your doctor can provide a better understanding of how long treatment will take.

When to see a doctor for perioral dermatitis?

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Perioral dermatitis is not contagious, is not often painful, and usually clears up on its own. However, many people find the rash difficult to live with, as it can be extremely visible. Attempts to cover the rash with makeup may only exacerbate the discomfort. If your rash has lasted longer than a couple of weeks, visiting a doctor is the best way to heal it faster. Additionally, if you have had perioral dermatitis in the past and see signs of a new rash occurring, visiting a doctor can help keep you ahead of symptoms as they appear.

How to prevent perioral dermatitis?

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Proactive lifestyle changes can help prevent perioral dermatitis. If you have had perioral dermatitis in the past, or if you are at an increased risk for developing the rash, consider these prevention methods:

  • Avoid topical steroids when possible. Topical steroids can serve as an essential treatment for certain conditions. Talk to your doctor about discontinuing their use if you suspect a rash forming.
  • Protect your skin from the sun. Wearing sunscreen and covering up protects your skin from ultraviolet rays. This, in combination with heat, can exacerbate or aggravate perioral dermatitis.
  • Replace or get rid of cosmetics. Heavy skin creams and cosmetics can aggravate the skin. If you notice a particular product causing a rash, try a different brand. A dermatologist can help make recommendations for what works best with your skin.

In some cases, perioral dermatitis is impossible to prevent. When this happens, visit your dermatologist. They can help ensure the rash heals quickly and efficiently.