Perioral dermatitisand why applying more does not help

The telltale clear rim

The rash sits as a ring around the mouth, while the skin directly against the lips stays unaffected. That narrow clear rim is the most characteristic sign and it is exactly what gives the rash its typical outline.

The medical name is perioral dermatitis, also written as dermatitis perioralis, and some doctors use the broader term periorificial dermatitis. It is sometimes called perioral eczema. When the rash sits around the eyes, doctors speak of periocular dermatitis. It is the same condition.

Is it your skincare routine?

Often, yes. Cleanser, toner, serum, cream, then an oil or a mask on top: the more products land on your face each day, the higher the chance of perioral dermatitis. Make-up, foundation and lip balm play a part too, as do facial cleansing products.

It is not about one bad product. It is about the stacking. The skin barrier is thrown off by the amount, not by a single culprit you can take out. That is also why switching to another brand rarely helps.

On top of that, there is one trigger that clearly stands out: creams and ointments containing corticosteroids, commonly known as steroid creams. More on that below.

What actually works for perioral dermatitis?

Leaving things out. That is the whole treatment, and it is the hardest one there is, because you do nothing while you want to do something.

In practice: stop all products on your face. Creams, serums, toners, make-up, foundation, lip balm, cleansing products and soap. Wash your face with lukewarm water only. If you use a corticosteroid cream on your face, stopping it is the most important step, but discuss that with a doctor first.

What does not work: switching to a milder brand, adding a nourishing cream, or using an anti-spot product. That last one often makes things worse, because perioral dermatitis is not acne.

Why it gets worse first

This is the point where most people give up, so it helps to know what is coming. After stopping, the rash usually flares first. Redder, more bumps, more burning. That often lasts one to several weeks.

That is not a sign that something is going wrong. It is the skin learning to function without the products. Anyone who starts applying again at that moment sees quick improvement and lands right back in the circle. That is how people keep perioral dermatitis going for months or years.

Holding out is therefore literally the treatment.

How do you recognise perioral dermatitis?

Small, red, fairly uniform bumps around the mouth, sometimes with light scaling. A narrow rim directly along the lip margin stays clear. The skin can itch mildly and often feels burning, tight or sensitive. Soap, water and sunlight can irritate it further.

The rash can extend to the folds beside the nose and sometimes to the area around the eyes. Perioral dermatitis mainly affects young women, and sometimes children.

Perioral dermatitis, acne or rosacea?

These three are often mixed up, and that is exactly why people spend months using the wrong products.

Perioral dermatitis characteristically sits around the mouth, with that clear rim along the lips, and consists of small uniform bumps.

Acne also produces blackheads and is spread across the face, often on the forehead, jawline and back as well.

Rosacea sits mainly on the cheeks and nose, with redness that comes and goes in flare-ups, and usually without blackheads.

The difference can be seen in the picture, but not always by yourself. Treat perioral dermatitis as acne and it usually gets worse.

What can you use?

In the first weeks, preferably nothing at all. Lukewarm water is enough. It feels bare, but it is the fastest route.

Once the worst of the flare has passed, you can carefully start with a simple base cream without active ingredients, such as lanette cream or cetomacrogol cream. These are available without a prescription at a pharmacy or drugstore and cause no symptoms themselves.

Rich and occlusive products are better left alone as long as the skin is not settled. Build up slowly after that and add one product at a time, so you notice what your skin reacts to.

Steroid creams and inhalers

The precise cause of perioral dermatitis is unknown, but one trigger stands out: corticosteroid cream or ointment on the face. The product suppresses the rash temporarily and keeps it going at the same time. The stronger the corticosteroid, the higher the chance.

If you use a corticosteroid inhaler for asthma, that can trigger perioral dermatitis too. Rinse your face and mouth with water after inhaling.

Never stop a prescribed steroid cream on your own without discussing it with a doctor.

Perioral dermatitis in children and babies

Perioral dermatitis occurs in children too, although less often than in young women. The approach is the same: stop creams and ointments on the face, and consult a doctor if a steroid cream is involved.

Note: a red ring around the mouth in a child is often caused by something else, namely a lot of lip licking or drooling. Confusingly, it looks almost the same, but it is a different condition with a different approach. Have it assessed instead of guessing.

Is perioral dermatitis contagious?

No. Perioral dermatitis is an inflammatory reaction of your own skin and does not pass to others. You can hug, kiss and share a glass as usual.

How long does perioral dermatitis last?

After stopping the triggers, the rash first gets worse for one to several weeks, and then gradually clears. Expect weeks to a few months.

With treatment through a doctor, recovery is often faster. Once healed, perioral dermatitis usually does not come back, provided you do not fall back into the same routine.

When to see a dermatologist?

Have your skin assessed if you are unsure whether it is perioral dermatitis, because it resembles acne and rosacea and those need a different approach. Also if the rash does not improve after several weeks of applying nothing, or if the symptoms are severe.

The doctor confirms the picture and, for persistent symptoms, can prescribe a cream or gel with an anti-inflammatory antibiotic, or a course of antibiotic tablets for extensive symptoms. If you use a steroid cream, the doctor discusses how to stop it safely.

What does it cost at 247dermatologist?

A consultation costs € 39 and you have an answer within 48 hours. Faster is possible too: € 59 within 24 hours, or € 79 within 12 hours. You need no referral and there is no waiting list. You send photos of your skin along.

You get back whether it is perioral dermatitis or something else, exactly what to stop, how long the flare-up lasts and what you can use again afterwards. If treatment is needed, the dermatologist prescribes it.

That last point is where most time is to be gained. People who mistake perioral dermatitis for acne buy products for months that make it worse.

Frequently asked questions

Sources and more information

• Dermatitis perioralis (nvdv.nl)