Overview

Perioral dermatitis is a type of rash that resembles acne. It typically develops around the mouth in adults and children. While women aged 16 - 45 years are more prone to it, it has also been reported to occur among children between the ages of 7 months and 13 years. Perioral dermatitis can be chronic and emotionally distressing. When the rash appears around the eyes and nose, it is sometimes called peri-orificial dermatitis. On light skin, it appears as a scaly or red bumpy rash, while on skin of colour, the bumps may be hyperpigmented or brown. The bumps may contain fluid, which can result in a clear fluid discharge and the rash may also cause slight itching and burning.^1,2 

Causes

The exact cause of perioral dermatitis is unknown, but it is noticed to be triggered by the use of steroid creams on the face. Steroid tablets or inhalers taken for another medical condition can also trigger the rash. Some researchers have suggested that an infectious source may cause the condition. Using fluoridated toothpaste, chewing gum, and dental fillings has been associated with perioral dermatitis as well. In some patients, certain cosmetic products, such as moisturisers, foundations, and physical sunscreens, are the cause. Hormonal factors may also play a role in the development of this condition, as it is more common in females. Interestingly, oral contraceptive pills have been linked to the improvement of perioral dermatitis.^1,2 

Treatment

Various treatment options are available, depending on the severity of the condition and how often it recurs. Topical corticosteroids are often used as the first-line therapy for perioral dermatitis. These medications reduce inflammation and redness, helping to alleviate symptoms. However, it can not be used by patients whose perioral dermatitis is developed while using topical steroid creams. In such cases, discontinuation of the creams is recommended. When topical corticosteroids are discontinued, symptoms may reappear within the first few weeks due to rebound flares. Therefore, it's essential to slowly reduce the use of the topical corticosteroid over several weeks to prevent this rebound flare from occurring. This gradual tapering off of the medication can help your skin adjust, minimising the severity of the symptoms and avoiding a sudden flare-up.^1,2  

Medications

A doctor can prescribe accurate medication after the disease is diagnosed. These medications can include:

Oral tetracycline

Perioral dermatitis is often treated with oral tetracycline. However, it is not recommended for children under 8 years old, as it may severely stain their developing teeth. The dosage of tetracycline can range from 250 mg twice daily to up to 500 mg twice daily in severe cases. The duration of treatment varies depending on how the patient responds and is typically around 4-8 weeks. Before starting the treatment, it is important to discuss the potential side effects, including gastrointestinal upset, diarrhoea, and rarely photosensitivity, as well as the rare possibility of elevated liver function tests.^1,3

Oral erythromycin / oral macrolides

It is not recommended for pregnant women and paediatric patients to take oral tetracycline. Instead, oral erythromycin can be used as an alternative. It was found that oral erythromycin 250 mg, taken two to three times per day, is less effective than tetracycline 250 mg, which is taken twice daily. However, oral erythromycin 250 mg still shows some degree of effectiveness in treating the condition. In some cases, the dosage can be increased to 500 mg per day. The time to cure varies from 1 to 12 months, depending on the severity of the condition and the patient's response to the treatment.^1,3

Oral doxycycline / oral minocycline

Doxycycline and minocycline are two medications that belong to the tetracycline family and are prescribed to treat various dermatologic conditions. They exhibit greater anti-bacterial activity than tetracycline and are particularly effective against acne, acne rosacea, and perioral dermatitis. However, minocycline may cause a range of side effects in female patients, including dizziness, nausea, and vomiting, while doxycycline may cause gastrointestinal upset, such as abdominal pain, diarrhoea, loss of appetite, and oesophagal irritation, which can lead to heartburn and difficulty swallowing.^1,3

Topical metronidazole

Topical metronidazole is a medication used for the treatment of perioral dermatitis. It works by suppressing the activity of bacterial skin flora and reducing inflammation. Metronidazole comes in various concentrations (0.75–2%) and preparation forms (gel, cream) and can be used with or without oral medication. Studies have shown that 1% metronidazole cream used for 8 weeks and 0.75% metronidazole gel used for 14 weeks are effective in resolving the symptoms of perioral dermatitis. However, using a higher concentration of 2% does not decrease the time to cure, and it takes longer (16 weeks) to see results. Oral tetracycline is generally found to be more effective than topical metronidazole, which is used as an optional medication for the treatment of perioral and periorificial dermatitis in paediatric patients. The average time to cure varies from 8 to 16 weeks.^1,3

Topical azelaic acid

Azelaic acid is a topical medication that has shown promising results in treating perioral dermatitis in adults and periorificial dermatitis in paediatric patients. This medication is effective in curing these skin conditions in 2-6 weeks for adults and 4-8 weeks for children. Azelaic acid is known for its antibacterial and anti-inflammatory properties, which help suppress the symptoms of these conditions. However, some side effects such as temporary burning sensation, increased redness, and scaling have been reported, particularly in the first two weeks of treatment.^1,3

Topical sulfacetamide and sulphur

Sodium sulfacetamide 10% and sulphur 5% combination is a medication that comes in the form of cream, lotion, suspension, and cleanser. It is commonly used to treat skin conditions such as acne, rosacea, and seborrheic dermatitis. The reason behind its effectiveness is attributed to its anti-microbial and anti-inflammatory properties. These properties help to reduce inflammation, prevent bacterial growth, and improve the overall appearance of the skin. However, one of the most notable drawbacks of this medication is its unpleasant odour. Despite this, it is generally well-tolerated, and no serious side effects have been reported.^1,3

Lifestyle changes 

If you're someone who has perioral dermatitis or wants to prevent it from happening, there are several actions you can take. Firstly, it's recommended that you use non-fluoridated toothpaste. Fluoride is known to prevent or reduce the severity of cavities and tooth decay, but it can also irritate the sensitive skin around your mouth.¹ 

It's also important to avoid using topical steroids, which are often used to treat skin conditions. While you should always follow your medical provider's instructions, it is best to avoid unnecessary use of topical steroids, especially if you have perioral dermatitis. Furthermore, it is advisable to avoid applying most topical products to the affected area. Instead, stick to neutral emollient creams, and vaseline until the rash clears up.¹ 

It is recommended that you change your skincare products, especially if you're using fragranced ones. It's best to consult a licensed dermatology provider to design a custom skincare routine that suits your skin type and needs. Adopting an anti-inflammatory diet can also help. While more research is needed to support dietary changes specific to perioral dermatitis, a well-balanced diet can support general skin health. Vitamins A, C, and E have proven skin benefits, while essential fatty acids and fruits and veggies rich in polyphenols can help improve elasticity, firmness, hydration, and pigmentation. If you are experiencing perioral dermatitis, there are some steps you can take to avoid worsening the condition.⁴

• It is important to avoid picking or squeezing the spots of the affected area. 
• Stop using all face creams, including topical steroids and cosmetics, unless otherwise advised by your healthcare professional
• Washing your face with water only until the condition has cleared up is also recommended. Once the condition has resolved, your healthcare professional may advise you to use a soap substitute to cleanse your face.
• Use of an unperfumed moisturiser is recommended if your skin is dry or sensitive.

Summary

Perioral dermatitis is a rash that can be mistaken for acne, typically appearing around the mouth in adults and children. While the exact cause is unknown, it can be triggered by factors like topical steroids, fluoridated toothpaste, or certain cosmetics, and is more prevalent in women between 16 and 45.

If you suspect perioral dermatitis, a doctor can recommend treatment based on the severity. Oral antibiotics like tetracycline or erythromycin are commonly prescribed. Topical medications like metronidazole or azelaic acid can also be effective. In addition to medication, several lifestyle changes can aid healing. Using non-fluoridated toothpaste and avoiding harsh skincare products are crucial. It's also recommended to avoid touching the rash and to temporarily stop using all face creams and cosmetics unless a doctor advises otherwise.

FAQs

What are the symptoms of perioral dermatitis?

People with perioral dermatitis typically experience a recurring red rash around the mouth which can be painful and persistent. The rash is often accompanied by burning and irritation of the skin. Perioral dermatitis usually affects the lower half of the face, including the area around the mouth, and may occasionally involve the areas around the eyes and nose. However, it usually does not affect the cheeks and forehead. It is important to seek medical attention if you suspect that you have perioral dermatitis, as it can be easily misdiagnosed and mistreated as other skin conditions.

How can perioral dermatitis be diagnosed?

Peri-oral dermatitis is typically diagnosed based on the appearance and distribution of the rash on the face, as well as the patient's medical history. It is often associated with the use of topical steroid creams, so your healthcare professional may ask about any previous use of such creams. Other tests, such as skin biopsies or cultures, are not usually required to diagnose perioral dermatitis. If you suspect that you have perioral dermatitis, it is important to seek medical attention from a dermatologist or other healthcare professional who can properly diagnose and treat the condition.

Is it possible for perioral dermatitis to heal on its own?

No, perioral dermatitis will not heal on its own and treatment from a doctor or dermatologist is mandatory. 

How long will it take for perioral dermatitis to get cured?

Expect a gradual improvement of this rash, which tends to clear slowly. It may take a few weeks or months to completely clear. Seeing a dermatologist and avoiding triggers can aid in treatment.

Is perioral dermatitis hereditary?

Perioral dermatitis is not considered to be a hereditary skin condition. It is believed to be caused by a combination of factors, including the use of certain topical products, hormonal imbalances, and other environmental factors. There is currently no evidence to suggest that perioral dermatitis is directly inherited.

Is perioral dermatitis contagious?

Perioral dermatitis is not contagious no matter which part of the body it occurs.