Overview

What is perioral dermatitis?

Perioral dermatitis (POD) is a common skin condition that presents as a red rash around the mouth. Perioral means around, and dermatitis means skin inflammation. It is also known as periorificial dermatitis as some other areas can be affected like the nose, eyes, chin, and rarely genitals, neck, scalp, and extremities. Perioral dermatitis is associated with the use of topical steroids and face cream. POD differs from acne, eczema, and rosacea, however they share similar features.¹

Who can be affected by perioral dermatitis?

The condition commonly affects people assigned female at birth age 25 to 45. Children can be affected as well, but it is not particular to gender or race in children.²

Symptoms of perioral dermatitis

The condition starts as a red rash around your mouth and may look darker on highly melanated people. The rash could be scaly, or dry and flaky. Sometimes there are inflamed bumps called papules. Later, you may develop vesicles (fluid-filled bumps), or pustules (pus-filled bumps). Itching and burning sensations could occur but not everyone experiences them.³

Causes and risk factors of perioral dermatitis

The exact cause of POD is yet to be determined, but several factors may increase your chance of getting it including the following:

• Topical steroid creams
• Steroid inhalers and sprays
• Moisturisers and face creams
• Cosmetic products and makeup
• Sunscreen
• Fluoridated toothpaste
• Dental fillings
• Hormonal imbalance or the use of oral contraceptives
• Immune system problems
• Damaged skin barrier
• Bacteria like follicular fusiform
• Fungi like candida albicans

Diagnosis of POD

Perioral dermatitis is usually diagnosed by clinical examination and taking a proper history. The appearance and rash are the distribution of the rash enough to diagnose. Sometimes a biopsy is required to differentiate it from other types of dermatitis.³

Treatment and management of perioral dermatitis

The first step to treat perioral dermatitis is to stop any products that could trigger the condition including topical steroids, face creams, cosmetic products, new fluoridated toothpaste and sunscreens.

Your healthcare provider can recommend several medications for the treatment of POD depending on your case.²

The first line of treatment for perioral dermatitis includes:

• Metronidazole cream or gel
• Clindamycin lotion or gel
• Erythromycin gel
• Topical sulphur preparations
• Azelaic acid gel
• Photodynamic therapy (PDT) using 5-aminolevulinic acid as a photosensitiser has been reported as beneficial
• Topical calcineurin inhibitors such as tacrolimus ointment or pimecrolimus cream have also been used and proven effective

The second line of treatment if topical medications are not effective is oral antibiotics, which help reduce the inflammation:

• Tetracycline
• Doxycycline
• Minocycline
• Erythromycin (for cases when tetracycline is contraindicated for pregnant and breastfeeding mothers, and children under the age of 8)

Topical medications are often used at the same time oral antibiotics are provided. It is important to consult with your GP or dermatologist before starting these medications.

Prognosis of perioral dermatitis

In some cases, the rash disappears after discontinuation of the triggering factor, but in most cases, POD takes a chronic course and can take months or years to resolve. Relapse can occur and the rash may appear again, but often the same treatments that worked the first time can be used and are likely to work again.

Complications of perioral dermatitis

• Stress is due to the chronicity of the condition and sometimes the relapse
• Scarring of the face may occur
• Poor quality of life and self-esteem because of the appearance of facial lesions

Prevention of perioral dermatitis

• Avoid using topical steroids and consult with your dermatologists if you have any skin condition that requires the use of topical steroids
• Use dermatologically approved face products that are gentle to your skin
• Commit to a simple skincare routine and minimise introducing many products at once
• Consult a dermatologist to know what products are healthy and suitable for your skin type

Difference between perioral dermatitis and other perioral skin conditions

Acne

Acne is different from POD in shape and distribution. Acne causes comedones (small flesh-coloured papules that give the skin a rough texture). Acne spots tend to be larger and can cause scars. They spread on wider areas of the face like cheeks, chin and forehead. However not limited to the face like POD.

Eczema

Even though eczema is called dermatitis, it is different from perioral dermatitis. Eczema does not cause pimples.

Rosacea

The only difference between perioral dermatitis and rosacea is the site of the spots. Rosacea spots tend to spread along the central third of the face, including the forehead, nose and chin. Rosacea can also cause redness and flushing.

FAQs

Is perioral dermatitis contagious?

No, it is not contagious and cannot spread to another person.

Can perioral dermatitis be cured?

There is no definitive cure for perioral dermatitis, but it can be resolved with the recommended treatments.

Can food worsen perioral dermatitis?

No food can worsen or make perioral dermatitis better.

Is perioral dermatitis a bacterial or a fungal infection?

The exact cause of perioral dermatitis is not well known, but some theories suggest that follicular fusiform (a type of bacteria) can cause POD. Candida albicans (a type of fungus) has also been suggested to be the cause of perioral dermatitis.³

Can perioral dermatitis be caused by stress?

Yes, stress can induce POD and some other types of dermatitis.

How long does it take to get rid of perioral dermatitis?

The rash tends to disappear gradually; it may take weeks or months for the rash to resolve completely after beginning the treatment and it differs from one person to another.

When should I see a healthcare provider?

As soon as you develop any rash, you should immediately contact your dermatologists to start the treatment before it worsens.

Summary

Perioral dermatitis (POD) is a common inflammatory skin condition that represents a red rash around the mouth but can also be around the eye, ear, nose, chin, and rarely trunk and genitals. Characterised by a red or dark red for highly pigmented skin colour, they can be dry and flaky, and sometimes vesicles and pustules may develop. The exact cause of POD is not fully understood, but it is believed to be related to a combination of factors including skin irritation from topical steroids and generally topical face products, hormonal fluctuations, and certain immune conditions.

Treatment typically involves avoiding potential triggers such as harsh skincare products, topical antibiotics, and/or oral medications such as antibiotics or anti-inflammatory drugs. It is very important to consult with your dermatologist in case of skin conditions for proper diagnosis and treatment.