Perioral Dermatitis

Medically Reviewed by Poonam Sachdev on January 30, 2024
Written by Alyson Powell Key
4 min read

Perioral dermatitis is a facial rash in which bumps develop around the mouth. In some cases, a similar rash may appear around the eyes, nose, forehead, or sometimes the genitals. Some experts call it a type of rosacea.

The condition is most commonly seen in young women (90% of cases), but it can affect men as well.

Although perioral dermatitis mainly affects young women, children can get it too. Like adults, the rash looks dry and bumpy and happens around the mouth, nose, and eyes. Sometimes it can turn red and scaly or look similar to acne.

Some experts consider perioral dermatitis to be a type of rosacea because they both usually improve with the same treatments. Rosacea shows up as red, pus-filled bumps, mostly in the middle of the face, including the nose.

Doctors don’t know exactly what causes perioral dermatitis. Possibilities include:

  • Corticosteroid medications that go on the skin (“topical” corticosteroids)
  • Nasal or inhaled corticosteroid medications that accidentally get on the skin
  • Infections
  • Toothpaste containing fluoride (not a proven cause, but it’s associated with perioral dermatitis)
  • Some cosmetic products
  • Some sunscreens

Because this condition is more common among young women, hormonal imbalances and birth control pills have been suggested as possible causes, but there’s no proof of that.

Perioral dermatitis isn’t contagious and is not passed down through genes.

Perioral dermatitis results in:

  • Bumps of skin around the mouth
  • A rash around the eyes, nose, forehead, or sometimes the genitals
  • Sometimes, an uncomfortable burning sensation around the mouth

 

Doctors can usually diagnose perioral dermatitis based on the skin’s appearance, with no tests needed.

Sometimes, doctors do a skin culture test for bacteria to see if there’s an infection.

In rare cases, doctors may do a skin biopsy if there’s something unusual about it or if treatments haven’t worked. In a biopsy, doctors take a little bit of the affected skin for testing.

Perioral dermatitis vs. acne

The way acne spreads on the skin may look like perioral dermatitis. Acne appears as red, pus-filled bumps, mainly on your face but sometimes on your back and chest. To tell whether you have acne, doctors look for blackheads or whiteheads, which are specific to the skin condition.

 

 

 

To treat perioral dermatitis:

  • Stop using all topical steroid medications and facial creams.
  • Ask your doctor if you need an antibiotic.
    • For mild cases, an antibiotic that goes on the skin may be enough. These include erythromycin and metronidazole.
    • Severe cases may need an oral antibiotic such as tetracycline or erythromycin.

Home remedies that can help include:

  • Change to mild, fragrance-free cleansers and moisturizers.
  • Be gentle when you wash your skin. Gently pat it dry. Don’t scrub it.
  • Stop using cosmetics or other products on the affected area while it’s healing unless your doctor says it’s OK.

Give it time. Perioral dermatitis may slowly clear up over a few weeks or months.

Perioral dermatitis medications

Other treatments for this condition include:

  • Clindamycin lotion or gel
  • Topical sulfur
  • Azelaic acid gel
  • Topical calcineurin inhibitors such as tacrolimus ointment or pimecrolimus cream
  • Topical adapalene
  • Photodynamic therapy using 5-aminolevulinic acid

Perioral dermatitis is most often seen in:

  • Young women
  • People using corticosteroid medications that go on the skin (topical)

 

This condition is more common during pregnancy. Talk to your doctor about the best treatment for perioral dermatitis while you're pregnant and breastfeeding. Some medications, such as tetracycline antibiotics, may be harmful.

 

While it may not be possible to prevent all cases, these steps may help:

  • If you use any topical steroid medications (those that go on your skin), follow the directions on the package, whether or not you needed a prescription to buy them.
  • Wash your hands after putting steroid medications on skin anywhere on your body, as any left on your fingers could get on your face if you touch that area.
  • To prevent perioral dermatitis from worsening, follow your treatment plan and be gentle in taking care of your skin.

 

Perioral dermatitis typically appears around the mouth but can also affect the eyes, nose, forehead, or genitals. It is more common in young women, but men and kids can get it too. Doctors aren't exactly sure what causes the condition, but factors like corticosteroid medications, infections, fluoride in toothpaste, and certain cosmetic products may play a role. Symptoms include skin bumps, a rash, and sometimes a burning sensation around the mouth, and treatment involves stopping the use of certain medicines, using antibiotics, and practicing gentle skin care.

Is perioral dermatitis fungal or bacterial?

Some experts think an infection of Candida albicans yeast (a fungus) causes perioral dermatitis. 

Why is perioral dermatitis worse at night?

Dermatitis tends to be worse at night for a couple of reasons. We all wake up briefly multiple times a night, and during these periods, itchiness may feel more intense, leading you to scratch and even bleed if you do it too much. Also, your internal clock, or circadian rhythm, plays a role. The hour or two before bedtime is when heat escapes from your hands, feet, and skin, making you feel itchier than usual. Studies suggest that children with dermatitis sleep the soundest between 2 a.m. and 4 a.m., which lines up with their coolest body temperatures.