Perioral Dermatitis: A Guide to Cure the Skin

Describe Perioral dermatitis.

Chronic inflammatory perioral dermatitis creates a red, bumpy rash around the lips, sometimes spreading to the nose and eyes. It manifests as clusters of tiny papules or pustules over redness and scaling and is often associated with topical steroid usage, cosmetics, or skin irritants.

Key Perioral Dermatitis Features

The condition is characterised by a scaly, flaky, red rash accompanied by pustules. It may involve the nose, eyes, and forehead. Particularly the lips. The skin may experience burning, itching, or tightness. Vermillion borders are frequently spared by the rash.

Causes and Risks

• Most common trigger: topical corticosteroids.
• Heavy cosmetics and moisturisers can clog pores.
• Use fluoridated toothpaste or dental products.
• Hormonal changes can occur due to the use of oral contraceptives, for example.
• Environmental factors include UV exposure and stress.
• Rare triggers, such as chewing gum, have been reported.

How does perioral dermatitis look?

Small red lumps, occasionally with pus, surrounded by inflammatory, flaky, or scaly skin around the mouth, nose, or eyes, are typical of perioral dermatitis. The vermillion border of the lips is generally spared, distinguishing the rash from other disorders.

Typical Look

• Red papules or pustules: Small lumps that resemble acne but are not real pimples.
• Background redness: Skin around pimples may appear irritated.
• Dryness or scaling: Rashes may have flaky spots.
• Distribution: • Mostly around the mouth.
• The rash has the potential to affect the nose, chin, or eyes.
• Lip sparing: The rash typically does not affect the lip surface.

What causes perioral dermatitis?

Usually induced by topical corticosteroids on the face, perioral dermatitis can also be caused by cosmetics, heavy moisturisers, fluoride toothpaste, hormonal changes, and environmental irritants, including UV exposure or wind. The key to controlling the illness is finding and eliminating these triggers.

Main causes and triggers

• Topical corticosteroids 
• The most common cause. Even moderate OTC hydrocortisone creams can cause it.
• Stopping steroids may exacerbate the rash before improving.
• Heavy products like balms, oils, primers, and moisturizers can clog pores and cause irritation.
• Common offenders include fragrance, essential oils, alcohol-based toners, and harsh scrubs.

Dental products

• Use toothpaste that contains fluoride or tartar-control agents.
• Strongly flavoured toothpastes (spicy or minty) may cause flares.
• Environmental considerations
• Sun exposure, wind, and inadequate photoprotection might aggravate symptoms.
• Climate change and stress may contribute.
• Hormonal factors: Oral contraceptives and hormonal variations might cause flare-ups.
• Unusual triggers
• Chewing gum is rarely cited as a cause.

Possible Risks

• The condition is more common in women aged 20-45.
• Skin type: Sensitive or reactive skin enhances sensitivity.
• Medical history: History of topical steroids or chronic skin disorders.

Who suffers from perioral dermatitis?

Men and children can get perioral dermatitis, but women between 20 and 45 are most likely.

Standard Affected Groups

• Adult women aged 20-45 years are more susceptible to the condition, likely due to their increased use of topical corticosteroids, cosmetics, and hormonal factors.
• Children may develop perioral dermatitis if topical steroids are applied to the face.
• Men: Rare but possible—often associated with shaving products, steroid creams, or dental irritants.

Possible Risks

• Use of topical corticosteroids, even modest hydrocortisone, may pose a risk.
• The use of cosmetics, such as moisturizers, makeup, and occlusives, can also pose potential risks.
• Dental products such as fluoridated or tartar-control toothpaste are also commonly used.
• Hormonal changes can occur due to the use of oral contraceptives and fluctuations in the menstrual cycle.
• Environmental factors: UV exposure, wind, and stress.
• Skin type: Sensitive or reactive skin enhances sensitivity.

Is perioral dermatitis contagious?

• Perioral dermatitis will not spread.

Why Not Contagious

• Inflammatory condition: Caused by irritation, steroid usage, or other triggers, not by contagious bacteria, viruses, or fungi.
• No person-to-person transmission: It cannot be spread through touch, utensils, or close contact.
• Each occurrence is linked to personal characteristics such as skincare products, toothpaste, or hormonal changes.

Important Note: 

Although not contagious, it may resemble acne or rosacea, causing confusion.  Avoid unneeded worry and improper treatment with proper diagnosis.

How is perioral dermatitis diagnosed?

Clinicians diagnose perioral dermatitis by inspecting the skin and asking about topical treatments, medications, and symptoms. No lab test exists.

Diagnosis steps

 Medical history

• The patient may have a history of long-term or recent use of topical corticosteroids on the face.
• Use cosmetics, moisturizers, or fluoridated toothpaste.
• Hormonal factors such as oral contraceptives and menstruation may also be present.

Physical examination

• Rash around lips, nose, or eyes.
• The examination reveals small red papules or pustules on a background of redness and scaling.
• The vermillion border (lip edge) is reduced.
• Exclusion of other conditions

The absence of comedones (blackheads/whiteheads) in perioral dermatitis rules out acne.

• Rosacea causes generalized redness and flushing beyond the perioral area.
• Seborrheic dermatitis: skin with oily scales, typically in scalp/nasolabial creases.
• Allergic contact dermatitis leads to itching and is connected to certain allergens.
• Additional tests are usually not required.
• Skin swabs or scrapings can rule out bacterial, fungal, or parasitic infections.
• Conduct patch testing for possible allergic contact dermatitis.

Treating perioral dermatitis

The video about how to treat Perioral Dermatitis

Stopping triggers (particularly topical steroids and irritating cosmetics) and employing gentle skin care and topical or oral antibiotics treat perioral dermatitis. Most cases improve within weeks after offending agents are removed.

Treatment Steps: 

1. Eliminate Triggers

• Stop using topical corticosteroids, including modest hydrocortisone.
• Withdrawal may induce a brief flare before recovery.
• Avoid heavy cosmetics and occlusive moisturizers (oily creams, thick balms).
• Change toothpaste if fluoridated or tartar-control types worsen symptoms.
• Reduce irritations: fragrance-heavy products, harsh scrubbing, and alcohol-based toners.

2. Topicals

• Metronidazole cream/gel: Anti-inflammatory and antibacterial.
• Erythromycin gel: Effective for mild instances.
• Use pimecrolimus or tacrolimus as non-steroid options for inflammation.
• Some use azelaic acid for its anti-inflammatory qualities.

3. Moderate to Severe Oral Treatments

• Tetracycline antibiotics, specifically doxycycline, minocycline, and tetracycline, are commonly used.
• These antibiotics are typically recommended for a period of 6–12 weeks.
• Macrolides (erythromycin, azithromycin) are available for youngsters and pregnant patients.

4. Skin Support

• Use mild, soap-free cleaners.
• Apply gentle, non-comedogenic moisturizers as needed.
• Avoid over-washing or scrubbing the affected region.
• Ensure skin is protected from sun and wind exposure.

Also, read https://torontodermatologycentre.com/perioral-dermatitis/.

Prevention and Long-Term Management

• Avoid reusing topical steroids on the face.
• Streamline skincare with fewer products, fragrance-free, and hypoallergenic options.
• Monitor hormonal effects (oral contraceptives may contribute).
• Inform patients that POD is not communicable but may recur if triggers return.

Risks and Factors

• Steroid withdrawal flare: Symptoms may temporarily intensify after stopping steroids.
• Recurrence: High if triggers are reestablished.
• Psychological impact: Visible rash might influence confidence and quality of life.

Overnight perioral dermatitis treatment?

Perioral dermatitis is a persistent inflammatory illness that takes weeks to months to heal, even with treatment. Trying to “get rid of it overnight” might frustrate and worsen the rash if harsh or incorrect therapies are employed.

Not Disappearing Overnight

• Inflamed skin needs time to settle down after the removal of triggers.
• Steroid withdrawal flare: Symptoms may worsen before lessening after stopping topical steroids.
• Timeline for treatment:
• Topical therapies: 2-4 weeks of improvement.
• Oral antibiotics: 4-8 weeks of improvement.

Do It Now

It won't go away overnight, but you can start healing:

• Stop topical steroids unless advised by a doctor.
• Simplify skincare by using light cleansers and avoiding heavy creams, oils, and makeup.
• Avoid fluoridated or tartar-control toothpaste if suspected as a cause.
• Avoid irritants like scents, scrubs, and alcohol-based toners.
• If outdoors, use light, non-comedogenic sunscreen to protect skin.

Conclusion

Patient and constant treatment are needed to treat perioral dermatitis, an inflammatory reaction. While avoiding triggers and commencing medical treatment is the fastest way to improve, outcomes take time.

Management relies on delicate skin care, avoiding steroids and irritants, and medical treatment as necessary. Preventing recurrence and reducing suffering requires patient education.