Perioral Dermatitis – The Ultimate Guide

Perioral dermatitis is a very complicated skin condition that a lot of people face and there is really not much information about it online.

This post contains everything there is you need to know about perioral dermatitis and by the end of this post you will have figured out what works for you.

So, let’s begin.

Perioral dermatitis is a red or pink rash that appears around the mouth, the folds of the nose, and occasionally the eyelid. It can be itchy, burning, dry, scaly, or flakey.

There can also be persistent grouped tiny erythematous papules, papulovesicles, and papulopustules sometimes on the background of pink, scaly or dry patches.

There is mild perioral dermatitis, severe perioral dermatitis, and a special form of perioral dermatitis called lupoid perioral dermatitis.

There are so many causes for perioral dermatitis.

• Damaged skin barrier

• Topical corticosteroids (TC)

• Excessive skin cleaning and washing

• Occlusive skin moisturizers like Aquaphor or Vaseline

• Chemical or physical sunscreens and cosmetic products containing retinol, niacinamide, vitamin C, and hyaluronic acid.

• Fluoridated toothpaste

• Fusobacteria, Candida albicans, Demodex folliculorum, and hormonal influences from the menstrual cycle or oral contraceptive therapy.

• Dust or unclean air conditioning

• Hot or cold weather

• Stress

• Dehydration

• Fragranced laundry detergents

• Lack of sleep

• Zero therapy

• Sunlight and lack of sunlight

• Dry air like central heating or car heating

• Wearing face masks for hours

• Alcohol especially red wine

• Makeup brushes and other makeup products

• Flonase nasal spray

• kombucha (one individual had a flare-up)

• Tap water and hot water

• Shampoos and conditioners

• Spicy foods and dairy foods

• Tears (some individuals got a flare-up)

Tetracycline antibiotics, such as doxycycline, minocycline, or tetracycline, can treat perioral dermatitis. Systemic erythromycin can be used as an alternative. For children younger than 12 years, pregnant women, and patients with contraindications to systemic tetracyclines, topical forms of metronidazole (most common), erythromycin, azithromycin, clarithromycin, adapalene, or azelaic acid can be used.

Elidel, protopic, rozex gel, soolantra, Lotrimin AF (clotrimazole), Lotrimin Ultra (if allergic to clotrimazole, then try this as it contains butenafine, another OTC antifungal), and epiceram are some other common medicines that your doctor might prescribe.

Other prescription meds include duac gel, prosacea, ketoconazole, fluconazole, tretinoin, neosporin, mupirocin, and hypochlorous acid.

When starting a skincare routine, try to make it as simple and minimal as possible. Here are some tips:

• Try to wash your face once a day. Hard water can be a trigger for most people, so you can use filtered water to wash your whole body.

• Make sure to avoid harsh cleansers and toothpaste with SLS or fluoride.

• Avoid toners or serums containing different ingredients.

• Avoid exfoliants like AHA/BHA/PHAs.

• The moisturizers can be lightweight and should be able to repair your skin barrier in case of a flare-up. Diaper rash creams with zinc oxide are best.

• When choosing sunscreen, go for physical sunscreens.

• Products containing manuka honey, zinc oxide, colloidal oatmeal, calendula, and sulfur can help with perioral dermatitis.

Note: all of these products should be fragrance-free and shouldn’t contain any sulfates and parabens.

• Avoid liquid foundations and switch to mineral powder makeup products. Bare Minerals and jane Iredale are some good brands.

• Make sure to wash your makeup brushes or switch to beauty blenders. You can also use tinted sunscreens or sunscreens with primer.

If the above tips worked but your PD hasn’t fully gone away, you can try changing your diet.

There are theories that PD is caused by Candida albicans (yeast), so taking Candida pills, probiotics, prebiotics, vitamins, or minerals along with trying out diets like keto or low-carb diet, and cutting out gluten, dairy, spicy foods, eggs, sugar, cinnamon and other similar spices, citrus fruits, nuts, caffeine, and alcohol can help.

Zero therapy is another method that can help to treat perioral dermatitis and a lot of people have had success with it. This can only work in mild forms of perioral dermatitis.

Zero therapy basically means not using any cosmetic products or medicines and just letting the skin heal by itself. You can wash your face with water (if hard water is a trigger, use filtered water or the LRP Thermal spring water) and use a humidifier to help with dryness.

Your skin will get worse before it gets better i.e. increase in itching, burning, redness, and dryness, so you will need to be patient before seeing any results.

Note: Zero therapy is not a cure for perioral dermatitis, so when you see that your rash has completely disappeared, go to a doctor, get your prescribed medicines, and start introducing products one by one to keep your PD at bay.

• Face oils like borage seed oil, tamanu oil, tea tree oil, rosehip oil, jojoba oil, black seed oil, evening primrose oil, castor oil, seabuckthorn oil, and coconut oil have worked for some people.

• Using the Selsun blue shampoo as a face mask has helped some people. You can apply it to wet skin for 1 minute and then rinse it off, once a day.

• Nizoral shampoo is another antifungal shampoo that may work. You can apply it to wet skin for 1 minute and then rinse it off, once a day.

• Cleansers

• Moisturizers

• Sunscreens

No, perioral dermatitis is not contagious as it is only a rash.

The first sign that you see is that your skin will be dry and flakey. This means that your perioral dermatitis is healing. Another sign is that your burning/itching and redness will start subsiding.

You will also notice the bumps start reducing and see fewer and fewer flare-ups. Once you see these signs, make sure to moisturize less and not so frequently.

You cannot get rid of perioral dermatitis overnight, it is a really slow process and requires a lot of patience. We recommend trying out zero therapy first before going for medical prescriptions and cosmetic products. Antifungal treatment will also work.

If you feel that Demodex mites might be the cause of your perioral dermatitis, then tea tree oil can help. Make sure to dilute it with another oil.

Gluten, dairy, spicy foods, eggs, sugar, cinnamon and other similar spices, citrus fruits, nuts, caffeine, and alcohol are some foods that might trigger perioral dermatitis.

If you have mild perioral dermatitis, you can try zero therapy. If zero therapy doesn’t work, then use tetracycline antibiotics or antifungal medicines along with a moisturizer that can help repair your skin barrier.

You can treat perioral dermatitis near or around your eyes by applying the same moisturizer you use near the mouth or other parts of your face. Tetracycline antibiotics can also work. Applying topical medicines can also work but make sure it doesn’t dry the skin out.

Yes, your perioral dermatitis can be Demodex mites in some cases. You can go to a doctor and get a skin biopsy done to check whether you have Demodex mites or not. Tea tree oil products can help with Demodex mites and also make sure to use a moisturizer.

Mild perioral dermatitis in children may be treated with a topical antibiotic, such as metronidazole, clindamycin, erythromycin and sulfacetamide. It can typically take 3 to 8 weeks.

Moderate to severe PD can be treated with oral antibiotics. The typical course of treatment is 4–8 weeks. Oral tetracyclines should be avoided in children under 12 years of age. In younger children, erythromycin, azithromycin, and clarithromycin are used.

Other treatments include 1% topical ivermectin, 20% azelaic acid cream, topical tacrolimus, pimecrolimus and adapalene gel.