Perioral Dermatitis: Causes, Symptoms & Treatment Guide

What Is Perioral Dermatitis?

Perioral dermatitis is an inflammatory skin condition characterized by red, bumpy rash around the mouth, chin, and nose. The condition primarily affects women between 20-45 years old and is often triggered by topical corticosteroid use, heavy cosmetics, or hormonal factors. It is not contagious and does not cause permanent scarring.

Perioral dermatitis is a distinct skin condition that falls somewhere between acne and eczema in its presentation. The name literally means "around the mouth" (perioral) "skin inflammation" (dermatitis), though the condition can also affect areas around the nose and eyes. Despite its somewhat alarming appearance, perioral dermatitis is a benign condition that responds well to treatment when properly diagnosed.

The condition was first described in the medical literature in the 1950s and 1960s, coinciding with the widespread introduction of topical corticosteroid creams. This timing was not coincidental—researchers soon discovered that prolonged use of these steroid creams on the face was a major contributing factor to the development of perioral dermatitis. This discovery fundamentally changed how dermatologists approach treatment, with cessation of topical steroids becoming a cornerstone of therapy.

Unlike many skin conditions that can occur anywhere on the body, perioral dermatitis has a very characteristic distribution pattern. The rash typically appears in a distinctive ring around the mouth, but with a notable clear zone immediately adjacent to the lip border. This spared area right next to the lips is actually one of the diagnostic features that helps doctors distinguish perioral dermatitis from other similar-appearing conditions like rosacea or allergic contact dermatitis.

Who Gets Perioral Dermatitis?

Perioral dermatitis shows a strong demographic pattern, predominantly affecting women between the ages of 20 and 45. Studies suggest that women are affected up to 10 times more frequently than men. This gender disparity is thought to relate to several factors, including higher rates of cosmetic product use, more frequent use of topical skincare treatments, and possibly hormonal influences. However, the condition can occur in men and children as well, though less commonly.

In children, perioral dermatitis has been increasingly recognized, often associated with inhaled corticosteroids used for asthma or topical steroids applied for eczema. The pediatric form typically affects children between 6 months and 16 years, with girls being more commonly affected even in this age group.

Is Perioral Dermatitis Contagious?

No, perioral dermatitis is absolutely not contagious. You cannot catch it from someone else or spread it to others through touching, sharing towels, or any other form of contact. The condition develops due to individual factors such as product sensitivity, hormonal changes, and skin barrier dysfunction—not from any infectious agent like bacteria or viruses. This is an important distinction because the appearance of the rash sometimes causes concern about contagion, but there is no risk of transmission.

What Are the Symptoms of Perioral Dermatitis?

Perioral dermatitis symptoms include red, scaly patches around the mouth with small papules (bumps) and pustules. The rash typically spares the skin immediately adjacent to the lip border. Many patients experience burning or mild itching, and the skin may feel tight or dry. The condition can also affect areas around the nose and eyes.

The symptoms of perioral dermatitis develop gradually and can vary in intensity from person to person. Understanding the full range of symptoms helps with early recognition and prompt treatment, which leads to better outcomes. The condition typically begins with subtle redness that may initially be mistaken for dry skin or mild irritation.

The hallmark of perioral dermatitis is a distinctive rash pattern around the mouth. This rash consists of small, red or flesh-colored papules (raised bumps) and sometimes pustules (bumps containing pus). These bumps are typically 1-2 millimeters in size and may cluster together to form larger patches of affected skin. The rash usually has a somewhat rough, bumpy texture that patients often describe as feeling like sandpaper.

One of the most characteristic features—and an important diagnostic clue—is that the skin immediately bordering the lips remains clear. This creates a distinctive ring pattern where the affected skin starts a few millimeters away from the lip line. This spared zone helps distinguish perioral dermatitis from other conditions like lip lick dermatitis, which affects the skin directly around the lip border.

Common Symptoms

• Redness and inflammation: The affected skin becomes visibly red and irritated. On lighter skin tones, this appears as obvious redness; on darker skin tones, the color change may appear more as darkening or subtle inflammation
• Small papules and bumps: Tiny raised bumps develop on the affected skin, sometimes filled with clear fluid or pus
• Burning or stinging sensation: Many patients report a burning feeling rather than typical itching, though mild itching can occur
• Dry, flaky skin: The affected areas may develop fine scaling or flaking
• Tightness: A feeling that the skin is stretched or tight, particularly after washing

Areas Affected Beyond the Mouth

While the classic presentation involves the area around the mouth, perioral dermatitis can extend to other facial areas. The condition can affect the skin around the nose (perinasal) and sometimes around the eyes (periocular). When it involves the eye area, it is sometimes called "periorificial dermatitis" to reflect the broader distribution. The periocular form can be particularly distressing as it may cause irritation near the delicate eye area and can be mistaken for allergic reactions or eczema.

It's important to note that perioral dermatitis does NOT typically cause:

• Blackheads or whiteheads: The absence of comedones helps distinguish it from acne
• Deep, painful nodules: Unlike cystic acne, the bumps remain superficial
• Flushing or visible blood vessels: These features are more suggestive of rosacea
• Scarring: The condition heals without leaving permanent marks

What Causes Perioral Dermatitis?

Perioral dermatitis is most commonly triggered by prolonged use of topical corticosteroids on the face. Other contributing factors include heavy occlusive cosmetics, fluoridated toothpaste, hormonal changes, and skin barrier disruption. The exact underlying cause is not fully understood, but it appears to involve immune dysregulation and disruption of normal skin flora.

The exact cause of perioral dermatitis remains incompletely understood, but research has identified several key triggering and contributing factors. The condition appears to result from a combination of external triggers and individual susceptibility, rather than a single cause. Understanding these factors is essential for effective treatment and prevention of recurrence.

The skin barrier plays a central role in the development of perioral dermatitis. When the protective barrier of the skin becomes compromised—whether through overuse of products, exposure to irritants, or other factors—it becomes more susceptible to inflammation. This barrier dysfunction allows environmental factors and microorganisms to trigger an inflammatory response, leading to the characteristic rash.

Topical Corticosteroids: The Primary Trigger

The most well-established trigger for perioral dermatitis is prolonged use of topical corticosteroid creams on the face. This association is so strong that some researchers have called the condition "steroid-induced perioral dermatitis." The mechanism is thought to involve several processes: corticosteroids thin the skin, alter the skin's microbiome (the natural balance of microorganisms), suppress local immunity, and can cause rebound inflammation when discontinued.

What makes this particularly problematic is that topical steroids initially seem to help—they reduce redness and inflammation in the short term. This leads many people to continue using them, creating a cycle of temporary improvement followed by worsening when the steroid is stopped. Breaking this cycle requires understanding that the short-term flare when stopping steroids is temporary and necessary for true healing.

Other Common Triggers

• Heavy cosmetics and skincare products: Occlusive (pore-blocking) makeup foundations, heavy moisturizers, and products containing certain fragrances or preservatives can trigger or worsen perioral dermatitis
• Fluoridated toothpaste: Some studies suggest that fluoride-containing toothpastes may contribute to the condition in susceptible individuals, though this remains somewhat controversial
• Hormonal factors: The higher prevalence in women and associations with oral contraceptives suggest hormonal influences, though the exact mechanism is unclear
• Inhaled corticosteroids: Steroid inhalers used for asthma can affect the perioral area if proper technique isn't used
• Sun exposure: UV light may trigger or worsen symptoms in some individuals

What Can I Do Myself for Perioral Dermatitis?

The foundation of self-care for perioral dermatitis is "zero therapy"—stopping all topical products including moisturizers, cosmetics, and especially corticosteroid creams. Wash your face with lukewarm water only, consider switching to fluoride-free toothpaste, and be patient as symptoms may temporarily worsen before improving.

Self-care measures form the foundation of perioral dermatitis treatment and can often be started before seeing a healthcare provider. The most important principle is elimination of potential triggers, which requires a disciplined approach to skincare routines that many patients find challenging initially.

The concept of "zero therapy" is central to treating perioral dermatitis. This approach involves completely stopping all topical products applied to the affected areas. While this may seem counterintuitive—especially when skin feels dry and uncomfortable—it allows the skin's natural barrier to repair itself without interference from potentially irritating products.

Steps for Self-Care

1. Stop all topical products: This includes moisturizers, makeup foundations, sunscreens, anti-aging products, and especially any corticosteroid creams. This is the single most important step and forms the basis of all treatment approaches.

2. Simplify your cleansing routine: Wash your face with lukewarm (not hot) water only. If you feel you must use a cleanser, use only the mildest, fragrance-free option available, and even then, use it sparingly. Avoid scrubbing or using any exfoliating products.

3. Consider your toothpaste: Switch to a fluoride-free, sodium lauryl sulfate (SLS)-free toothpaste. While the evidence for this is not conclusive, many dermatologists recommend it as a low-risk intervention that may help some patients.

4. Be patient with the initial flare: When you stop using products—especially if you've been using corticosteroid creams—expect your symptoms to temporarily worsen. This "rebound" phase can last 1-2 weeks but is a normal part of the healing process. Understanding this helps prevent the temptation to resume using steroids.

5. Protect without occluding: If sun protection is needed, discuss with your healthcare provider about the safest options. Mineral-based sunscreens may be better tolerated than chemical sunscreens.

When Should You See a Doctor for Perioral Dermatitis?

See a doctor or dermatologist if your symptoms persist for more than 2-3 weeks despite stopping potential triggers, if the rash is spreading or severe, if you have involvement around your eyes, or if over-the-counter measures are not helping. A healthcare provider can prescribe effective treatments and confirm the diagnosis.

While mild cases of perioral dermatitis may improve with self-care measures alone, many cases benefit from professional evaluation and treatment. Knowing when to seek medical care helps ensure timely treatment and prevents unnecessary prolongation of symptoms.

A dermatologist or healthcare provider can confirm the diagnosis, as perioral dermatitis can sometimes be confused with other conditions such as rosacea, allergic contact dermatitis, or seborrheic dermatitis. Accurate diagnosis is important because the treatment approaches differ significantly. For example, topical steroids—which worsen perioral dermatitis—might be appropriate for some other conditions.

Reasons to Seek Medical Care

• Persistent symptoms: If your rash hasn't improved after 2-3 weeks of stopping potential triggers and following self-care measures
• Spreading or worsening: If the affected area is expanding or symptoms are becoming more severe
• Eye area involvement: Periocular (around the eyes) involvement should be evaluated by a professional
• Uncertain diagnosis: If you're not sure whether you have perioral dermatitis or another condition
• Need for prescription treatment: More severe cases often require prescription medications for resolution
• Impact on quality of life: If the condition is causing significant distress or affecting your daily activities

During your appointment, the healthcare provider will typically examine the affected areas and ask about your skincare routine, any products you've used, and your medical history. In most cases, perioral dermatitis can be diagnosed based on its characteristic appearance and distribution pattern. Skin biopsies are rarely necessary but may be performed if the diagnosis is uncertain.

How Is Perioral Dermatitis Treated?

Treatment for perioral dermatitis involves stopping all triggering products (zero therapy) and, for persistent cases, prescription medications. First-line treatments include topical metronidazole or azelaic acid. More extensive cases may require oral antibiotics such as tetracyclines (doxycycline or minocycline) for 6-12 weeks. Treatment typically leads to clearance within 2-3 months.

The treatment of perioral dermatitis follows a stepwise approach, beginning with elimination of triggers and progressing to prescription medications when necessary. The good news is that perioral dermatitis generally responds well to treatment, with most cases resolving completely within a few months.

The foundation of all treatment is stopping the use of topical corticosteroids and other potentially irritating products. This aspect cannot be emphasized enough—continuing to use steroids on the face will prevent healing regardless of what other treatments are used. For many mild cases, this "zero therapy" approach combined with time is sufficient for resolution.

Topical Treatments

For cases that don't respond adequately to zero therapy alone, topical prescription medications are usually the first step. These are applied directly to the affected skin and are generally well-tolerated with minimal side effects.

• Topical metronidazole: Available as a gel or cream (0.75% or 1%), metronidazole is one of the most commonly prescribed treatments. It has both anti-inflammatory and antimicrobial properties. Apply once or twice daily for 8-12 weeks.
• Topical azelaic acid: Available in 15-20% formulations, azelaic acid is an effective alternative or addition to metronidazole. It can be particularly helpful for those who don't tolerate metronidazole.
• Topical pimecrolimus: A non-steroidal immunomodulator that can be effective for perioral dermatitis, especially when used after the acute phase has subsided.
• Topical erythromycin: An antibiotic that may be used for its anti-inflammatory properties in milder cases.

Oral Treatments

When topical treatments alone are insufficient, or when the condition is more widespread or severe, oral antibiotics may be prescribed. The antibiotics used are typically tetracyclines, which work through both antimicrobial and anti-inflammatory mechanisms at the lower doses used for skin conditions.

• Doxycycline: The most commonly prescribed oral treatment, typically at doses of 40-100mg daily. Lower "sub-antimicrobial" doses (40mg) are often effective and have fewer side effects.
• Minocycline: An alternative tetracycline that may be used if doxycycline is not tolerated or available.
• Oral erythromycin: May be used in those who cannot take tetracyclines, such as pregnant women or children under 8 years old.

Oral antibiotic treatment is typically continued for 6-12 weeks, with improvement usually seen within the first few weeks. The medication is gradually tapered or stopped once the condition has cleared, and patients are counseled about avoiding triggers to prevent recurrence.

What Is the Long-Term Outlook for Perioral Dermatitis?

The prognosis for perioral dermatitis is excellent. The condition typically resolves completely with treatment within 2-3 months and does not cause permanent scarring. While recurrence is possible (sometimes after years), most patients do not experience repeated episodes. Avoiding known triggers helps prevent recurrence.

Perioral dermatitis has an excellent prognosis when properly treated. Unlike some chronic skin conditions that require lifelong management, perioral dermatitis typically resolves completely and may never return. This is reassuring for patients who are often concerned about the visible nature of the condition and its potential long-term impact.

One of the most important things to know is that perioral dermatitis does not cause permanent scarring. Even when the condition has been present for extended periods or covers large areas, the skin returns to normal after successful treatment. This distinguishes it from conditions like severe acne, which can leave lasting marks.

The healing process may leave temporary changes in skin color (post-inflammatory hyperpigmentation or hypopigmentation), particularly in those with darker skin tones. These color changes typically fade over several months following treatment, though the process can take up to a year in some cases.

Risk of Recurrence

After successful treatment, perioral dermatitis may recur in some patients, though this is not the rule. When recurrence happens, it typically occurs after several years rather than immediately after treatment. Importantly, subsequent episodes generally respond to the same treatments that worked initially, so recurrence, while frustrating, is manageable.

Factors that may increase recurrence risk include:

• Resuming use of topical corticosteroids on the face
• Return to heavy cosmetic use
• Incomplete initial treatment
• Ongoing exposure to triggering factors

How Can You Prevent Perioral Dermatitis?

Prevent perioral dermatitis by avoiding topical corticosteroids on the face, using minimal skincare products, choosing non-comedogenic cosmetics, and being cautious with new products. Once you've had perioral dermatitis, maintain a simple skincare routine and avoid known triggers to prevent recurrence.

Prevention of perioral dermatitis focuses on avoiding known triggers, particularly the misuse of topical corticosteroids. For those who have never had the condition, awareness of risk factors can help prevent the first episode. For those who have recovered from perioral dermatitis, prevention strategies help minimize the risk of recurrence.

Prevention Strategies

Avoid topical steroids on the face: Never apply corticosteroid creams to facial skin unless specifically prescribed by a dermatologist for a diagnosed condition—and even then, use them only for the prescribed duration. This includes over-the-counter hydrocortisone creams.

Keep skincare simple: Use a minimal number of products on your face. The more products you use, the greater the chance of encountering an ingredient that triggers problems. When introducing new products, do so one at a time to identify any that cause issues.

Choose products carefully: When you do use skincare products or cosmetics, select those labeled as non-comedogenic (won't block pores), fragrance-free, and hypoallergenic. Avoid heavy, occlusive products.

Practice proper inhaler technique: If you use inhaled corticosteroids for asthma, use a spacer device and rinse your mouth after use to minimize drug deposition around the mouth.

Consider your toothpaste: If you've had perioral dermatitis, using fluoride-free and SLS-free toothpaste may help prevent recurrence, though evidence for this is limited.