Introduction

Definition of perioral dermatitis

Perioral dermatitis is a benign skin condition characterised by the development of small inflammatory papules, pustules, or pink, scaly patches predominantly around the mouth region. While its name suggests a focus on the mouth area, it can also extend to affect the skin around the eyes and nose. This condition is often referred to as periorificial dermatitis due to its potential to involve the periocular (around the eyes) and paranasal (around the nose) regions as well.¹

Prevalence in breastfeeding people

Perioral dermatitis primarily affects young, assigned female at birth (AFAB) adults, typically within the age range of 20 to 45 years. Although it is more commonly observed in this demographic, cases have also been reported in children. Despite its benign nature, perioral dermatitis can significantly impact quality of life, particularly in affected individuals in their reproductive years.¹ 

Importance of managing perioral dermatitis during breastfeeding

Managing perioral dermatitis during breastfeeding is crucial for both maternal and infant well-being. Given the prevalence of the condition in young, AFAB adults who are the most likely demographic to become pregnant, after which many of whom are breastfeeding, effective management becomes paramount. Moreover, the hormonal changes associated with breastfeeding may influence the severity and recurrence of perioral dermatitis. Therefore, implementing appropriate treatment and management strategies is essential to alleviate symptoms, prevent complications, and ensure the continuation of breastfeeding without unnecessary discomfort or interruption.¹

Understanding perioral dermatitis

Definition and symptoms

Perioral dermatitis and its variants, such as periorificial dermatitis, are skin disorders characterised by the appearance of small red bumps resembling acne or rosacea. These bumps typically emerge on the lower half of the face, particularly in the folds around the nose and mouth. The condition can also manifest as a similar rash around the eyes, nose, or forehead². Common symptoms of perioral dermatitis include a burning sensation around the mouth, particularly in the creases between the nose and mouth. The affected area may develop bumps filled with fluid or pus, resembling acne. The rash may be itchy and uncomfortable. In some cases, the rash may recur, especially if steroid-containing (corticosteroid) creams are applied to the skin.²

Causes and triggers

The precise cause of perioral dermatitis remains unknown, but several factors may contribute to its development. One common trigger is the use of face creams containing steroids, particularly when applied for other skin conditions. Additionally, periorificial dermatitis may be brought on by various factors including:

• Topical steroids applied intentionally or accidentally to the face
• Use of nasal steroids, steroid inhalers, or oral steroids
• Cosmetic creams, make-ups, and sunscreens
• Fluoridated toothpaste
• Inadequate facial hygiene, such as failing to wash the face regularly
• Hormonal changes, including those associated with oral contraceptives²

Risk factors

Perioral dermatitis primarily affects young AFAB people, although it can also occur in children. Individuals using topical corticosteroids, whether for medical reasons or cosmetic purposes, are at increased risk of developing this condition. Additionally, hormonal changes, such as those occurring during puberty or as a result of oral contraceptive use, may elevate the risk of perioral dermatitis.²

Impact of breastfeeding on perioral dermatitis

Hormonal changes during breastfeeding and their effects on skin

During breastfeeding, hormonal changes can significantly affect the skin and may exacerbate conditions like perioral dermatitis. The fluctuation in hormone levels, particularly oestrogen and progesterone, can influence oil production and immune responses in the skin, potentially leading to the development or worsening of perioral dermatitis.³

The postpartum period, including the breastfeeding phase, is characterised by hormonal shifts as the body adjusts to the changes associated with childbirth and lactation. These hormonal changes can impact various physiological processes, including skin health.

Oestrogen and progesterone levels typically decrease after childbirth, which can lead to changes in skin texture, moisture levels, and immune responses. These alterations may contribute to increased susceptibility to skin conditions like perioral dermatitis.³

Potential exacerbating factors

In addition to hormonal changes, several other factors may exacerbate perioral dermatitis during breastfeeding:

1. Use of topical cosmetic products: Occlusive cosmetic products containing ingredients like paraffin or petrolatum may exacerbate perioral dermatitis by trapping moisture and impeding the skin's natural barrier function³
2. Exposure to corticosteroids: Intentional or unintentional exposure to topical corticosteroids, whether through prescribed medications or over-the-counter products, can worsen perioral dermatitis. It's crucial for breastfeeding individuals to avoid using corticosteroids on the face without medical advice and supervision³
3. Contact allergens: Allergens present in skincare products, environmental pollutants, or certain foods may trigger or aggravate perioral dermatitis. Identifying and avoiding these allergens can help manage the condition during breastfeeding³
4. Microbiological factors: Microorganisms like Candida, Demodex mites, or fusiform bacteria may play a role in the development or exacerbation of perioral dermatitis. Maintaining good facial hygiene and avoiding factors that promote microbial growth can aid in managing the condition³

Managing perioral dermatitis while breastfeeding

General skin care tips for breastfeeding mothers

Perioral dermatitis is a common skin condition that can be influenced by hormonal changes during pregnancy and breastfeeding. To manage perioral dermatitis while breastfeeding, it's essential for mothers to adopt gentle skin care practices and use safe treatment options to ensure both maternal and infant well-being.⁴

Safe treatment options during breastfeeding

1. Topical antibiotics: Topical erythromycin is considered safe for use during breastfeeding and can help reduce inflammation associated with perioral dermatitis. Apply a thin layer of erythromycin cream or gel to the affected area as directed by your healthcare provider⁴
2. Benzoyl Peroxide: Benzoyl peroxide is generally considered safe for use during breastfeeding when applied topically in low concentrations. It can help unclog pores and reduce bacterial growth associated with perioral dermatitis⁴
3. Azelaic Acid: Azelaic acid is another safe option for treating perioral dermatitis while breastfeeding. It has anti-inflammatory and antimicrobial properties that can help improve symptoms without posing a risk to the nursing infant⁴

Avoiding common triggers

1. Topical corticosteroids: Avoid using topical corticosteroids (such as hydrocortisone) on the face without medical supervision, as these can exacerbate perioral dermatitis and may be absorbed systemically (throughout the body), potentially affecting the nursing infant⁵
2. Cosmetic products: Choose skincare and cosmetic products labelled as "non-comedogenic" and free from potential irritants like paraffin, petrolatum, and fragrances. Be cautious with heavy creams and makeup that may worsen perioral dermatitis⁶
3. Environmental factors: Minimise exposure to environmental triggers such as harsh weather conditions, pollution, and ultraviolet (UV) radiation, which can irritate the skin and exacerbate perioral dermatitis symptoms⁵

By adopting gentle skin care practices, using safe treatment options, and avoiding common triggers, breastfeeding parents can effectively manage perioral dermatitis while ensuring the health and well-being of both themselves and their infants. Consult with a healthcare provider or dermatologist for personalised recommendations tailored to your specific needs.

Long-term management and prevention

Successfully managing perioral dermatitis involves not only treating current symptoms but also implementing strategies to prevent recurrence and maintain skin health in the long term. By incorporating simple yet effective skincare practices and lifestyle adjustments, individuals can minimise the likelihood of future episodes of perioral dermatitis.⁶

Strategies for preventing recurrence

Choose non-comedogenic products: Opt for skincare and cosmetic products labelled as non-comedogenic, meaning they are formulated to avoid clogging pores. Check labels and ingredients carefully to avoid facial oils and occlusive balms that may exacerbate perioral dermatitis⁶.

Gentle cleansing: Cleanse your face gently using mild, non-irritating cleansers that won't strip the skin of its natural oils. Avoid overwashing, as harsh cleansers can disrupt the skin's protective barrier and potentially trigger perioral dermatitis flare-ups.⁶

Stress management: While eliminating stress entirely may be challenging, incorporating stress-relieving activities into your daily routine can help mitigate many skin conditions, including perioral dermatitis by reducing stress. Engage in activities such as meditation, yoga, deep breathing exercises, or hobbies that promote relaxation and soothe the mind.⁶

Incorporating skincare into post-breastfeeding routine

Continue gentle skin care practices: Even after breastfeeding, maintaining gentle skin care practices is essential for preventing perioral dermatitis recurrence. Stick to non-comedogenic products and avoid harsh cleansers or irritating ingredients that may disrupt the skin's balance.

Regular moisturisation: Keep the skin well-hydrated with a lightweight, non-comedogenic moisturiser to maintain its natural moisture barrier. Moisturising regularly can help prevent dryness and irritation that may contribute to perioral dermatitis.⁶

Consulting a dermatologist

If you have any concerns or questions about perioral dermatitis or notice changes to your skin, consult a dermatologist for personalised advice and treatment. A dermatologist can assess your skin condition, recommend appropriate skincare products, and develop a tailored treatment plan to address your specific needs, helping you maintain radiant, healthy skin in the long term.

Summary

In conclusion, perioral dermatitis can present unique challenges for breastfeeding mothers, but with proper management and care, it is possible to navigate this condition effectively while continuing to breastfeed. By understanding the nature of perioral dermatitis, its triggers, and safe treatment options, mothers can take proactive steps to alleviate symptoms and prevent recurrence.

Key points

• Perioral dermatitis is a benign skin condition characterised by small inflammatory papules, pustules, or pink, scaly patches predominantly around the mouth region
• Hormonal changes during pregnancy and breastfeeding can influence the severity and recurrence of perioral dermatitis, making effective management essential for maternal and infant well-being
• Safe treatment options during breastfeeding include topical antibiotics like erythromycin, benzoyl peroxide, and azelaic acid while avoiding triggers such as topical corticosteroids and certain cosmetic products
• Long-term management and prevention strategies focus on gentle skin care practices, stress management, and avoiding common triggers to minimise the likelihood of future episodes
• Consulting a dermatologist can provide personalised advice and treatment plans tailored to individual needs, ensuring optimal skin health for both mother and infant

Encouragement for breastfeeding parents

Breastfeeding parents facing perioral dermatitis should remember that they are not alone in their journey. With patience, perseverance, and the right support, it is possible to manage this condition effectively while continuing to provide nourishment and care for their infants.

Final advice and resources for further support

For additional support and guidance, breastfeeding parents can consult with healthcare providers, lactation consultants, or dermatologists experienced in treating perioral dermatitis. Online resources, support groups, and forums dedicated to breastfeeding and skin health may also provide valuable information and peer support.

Remember to prioritise self-care, seek professional assistance when needed, and celebrate the joys of breastfeeding while managing perioral dermatitis. With dedication and resilience, parents can overcome this challenge and embrace the journey of parenthood with confidence and grace.