What is perioral dermatitis? Causes, symptoms and what helps

Key takeaways

• Perioral dermatitis is a common rash of small red or skin-colored bumps around the mouth, and sometimes the nose and eyes. It often leaves a clear strip right next to the lips.

• Steroid creams are the best-documented trigger, including nasal sprays and inhalers. Heavy creams and some cosmetics can make it worse.

• Stopping all face products, called “zero therapy,” can clear mild cases on its own.

• A rebound flare is common after stopping a steroid cream. Don’t start using it again.

• It usually takes weeks to a few months to clear. See a dermatologist if it doesn’t improve after you stop steroids and heavy products.

What is perioral dermatitis?

Perioral dermatitis is an inflammatory rash that tends to show up around the openings on the face. DermNet describes it as “a relatively common chronic inflammatory skin eruption” that targets the skin around the eyes, nostrils and mouth. That’s why the American Academy of Dermatology (AAD) says “peri-orifical dermatitis” is actually a more accurate name.

It’s most common in women, roughly between 16 and 45, according to Harvard Health, though it can affect anyone, including young children. The AAD says it isn’t contagious.

What does perioral dermatitis look like?

The AAD says it often looks like small, red, acne-like bumps on lighter skin and skin-colored bumps on darker skin, usually with dry, flaky skin in the same area. DermNet describes clusters of tiny bumps and pustules, usually under 2 mm each, sometimes with burning or tightness.

A few details help identify it:

• A clear band around the lips. DermNet notes the skin right next to the lip line is often spared.

• The creases beside the nose. MedlinePlus says the creases between the nose and mouth are most affected.

• The nose and eyes. It can also appear around the nostrils and eyes.

It can look like acne or rosacea, but DermNet notes acne usually has blackheads, nodules or cysts, which aren’t typical of perioral dermatitis, and rosacea tends to affect older people and a different pattern of skin.

What causes perioral dermatitis?

The AAD says it’s not entirely clear what causes it, but several triggers come up again and again:

• Steroid creams, sprays and inhalers. DermNet calls steroid use by any route, including creams, nasal sprays and inhalers, “the most common association.” A 2021 systematic review found the strongest evidence points to topical steroid misuse as the main cause.

• Heavy creams. DermNet and Harvard Health both list heavy or occlusive moisturizers.

• Cosmetics and sunscreens. MedlinePlus lists cosmetic creams, makeup and sunscreens, and DermNet notes physical sunscreens can trigger it in children. Our guide to mineral vs chemical sunscreen explains the difference.

• Fluoride toothpaste. It’s often listed as a possible trigger, but the evidence comes mainly from individual case reports.

• Hormones and weather. DermNet notes flares linked to birth control pills, pregnancy and periods, and says UV light, heat and wind seem to make it worse.

Zero therapy: stopping everything

For many people, the first step is to stop. DermNet says the “zero-therapy approach should be utilised in all POD patients and may result in complete resolution of mild cases.” That means stopping all facial cosmetics and topical products, including sunscreens and moisturizers, and washing with warm water alone until the rash clears. A 2010 review found the evidence most strongly supports zero therapy, along with pimecrolimus cream, oral tetracycline and erythromycin cream.

The AAD adds that you may need to switch to a mild, fragrance-free cleanser and be very gentle when you wash. Our guide to repairing a damaged skin barrier covers a simpler routine once the rash settles.

Why it can flare after you stop steroids

This is the hardest part. The AAD warns: “When you stop applying a corticosteroid or hydrocortisone cream, the rash can worsen. If this happens, it can be tempting to start using the cream or ointment again. Don’t.” Using it again only brings temporary relief.

A few things to know:

• Talk to your doctor first. The AAD says to check with the doctor who prescribed a steroid before you stop it. A UK clinical guide suggests tapering over one to two weeks can reduce the flare.

• Keep necessary medicines. DermNet says medically necessary nasal, inhaled and oral steroids should be continued, though they may slow recovery. Rinsing your face and mouth after using a nasal spray or inhaler may help.

How is perioral dermatitis treated?

If zero therapy isn’t enough, a doctor may prescribe:

• Topical creams, such as metronidazole, erythromycin or pimecrolimus, according to DermNet.

• Oral antibiotics, such as tetracycline or doxycycline, often for several weeks. DermNet lists erythromycin as the first choice for pregnant women and children under 8.

The evidence behind these is limited. A 2022 systematic review found oral tetracycline and pimecrolimus cream may improve severity, but rated the overall evidence low or very low certainty, and found azelaic acid gel may make no difference in severity after six weeks. A recent review in the Journal of the American Academy of Dermatology notes that no treatment is specifically approved by the FDA for perioral dermatitis.

How long does perioral dermatitis take to clear?

It’s slow. The AAD says it “may take a few weeks or a few months to clear completely.” DermNet puts typical treatment at four to eight weeks and says stopping too soon can bring it back. Without treatment, DermNet says it can last months to years.

MedlinePlus notes it doesn’t come back after treatment in most cases, but it’s more likely to return if you use skin creams that contain steroids.

When to see a dermatologist

Cleveland Clinic suggests seeing a dermatologist if the rash doesn’t clear after you’ve stopped topical steroids. It’s also worth seeing one if you’re not sure what the rash is, since it can look like hormonal acne, rosacea or fungal acne, which each need different treatment.

Frequently asked questions

Can perioral dermatitis go away on its own?

Mild cases often clear once you stop steroid creams, heavy products and cosmetics. DermNet says zero therapy may clear mild cases completely. Stubborn cases usually need a prescription.

What is the main cause of perioral dermatitis?

The strongest evidence points to steroid use on or near the face, including creams, nasal sprays and inhalers. Heavy creams, some cosmetics and sunscreens are other common triggers.

Why did I suddenly get perioral dermatitis?

It often starts after using a steroid cream or a new heavy moisturizer, makeup or sunscreen. Hormonal changes and heat can also trigger flares. The exact cause isn’t always clear.

Is perioral dermatitis contagious?

No. The AAD says you can’t catch it from someone else.

What should I put on perioral dermatitis?

Often, nothing at first. DermNet recommends stopping all topical products and washing with warm water until the rash clears. If it doesn’t improve, a dermatologist can prescribe a cream or antibiotic.