What Is Perioral Dermatitis? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Perioral dermatitis is a skin condition characterized by a red rash around the mouth. It is one type of dermatitis, which is a general term to describe skin irritation. In the word “perioral,” “peri” means “around" and “oral” refers to the mouth.

People with perioral dermatitis have a visible rash around their mouth, says Peter Lio, MD, a dermatologist at Northwestern Memorial Hospital in Chicago.

“Typically, it would present as small red papules, or bumps, around the mouth and sometimes nose and eye areas,” he says. “Unlike mild irritation in these areas, this rash persists for weeks and beyond.”

Additionally, perioral dermatitis is often associated with redness and scaling, says Arielle Nagler, MD, a dermatologist at NYU Langone Health.

“Patients often complain of itching and burning,” she says. “Since certain topicals can exacerbate perioral dermatitis and treatments are all by prescription, medical care is recommended.”

“Using steroids around the mouth — including inhaled steroids for asthma — is a common trigger in children,” Dr. Lio says.

During the COVID-19 pandemic, dermatologists saw a rise in perioral dermatitis as a result of face masks. Anna Lien-Lun Chien, MD, an associate professor of dermatology at Johns Hopkins University School of Medicine in Baltimore, said her practice noted an increase in cases during the pandemic.

“Unfortunately with the mask in place, it creates a different environment,” she says. “It changes the barrier of the skin in that area. Especially for an individual who’s more sensitive or prone to this inflammation, they can start developing those breakouts.”

In some cases of perioral dermatitis, a skin-care product or even a particular toothpaste may be the culprit, Lio says.

The skin condition can affect anyone at any age, but children and women are most affected, Lio says.

“Any new rash is potentially worth seeking medical care for, but especially more severe and persistent rashes would warrant reaching out,” Lio says. “While there are not too many concerning things that can mimic this, sometimes bacterial or viral infections can be similar, and those should be promptly diagnosed and treated.”

He notes that most patients will first see their primary care doctor, but if the rash is not responding to treatment or the diagnosis is unclear, a visit to a board-certified dermatologist can be helpful.

“There is not a lot of data on recurrence after resolution; however, in my experience recurrences are common and can even occur years after successful treatment,” Dr. Nagler says.

There is no specific FDA-approved treatment for perioral dermatitis, Lio says. Sometimes it may clear up on its own. Yet some people will need the help of a healthcare provider. There are several approaches you can take to relieve symptoms.

For cases that don’t respond to these practical steps, dermatologists will typically treat perioral dermatitis in a similar way to rosacea, Lio says.

“The first-line treatment is a topical therapy that we might use for rosacea: metronidazole (Flagyl) cream or ivermectin (Stromectol) cream, usually applied twice daily,” he says. “Sometimes I will add in a sulfur-based cleanser as well.”

If that doesn’t work or if the condition is severe, oral antibiotics like doxycycline may be prescribed to manage inflammatory issues, Lio says.

“In children, sometimes we will use azithromycin or erythromycin instead,” he says. “Usually, a few weeks of these anti-inflammatory antibiotics seems to break the cycle.”

Prevention of Perioral Dermatitis

Keep your skin-care routine simple. “Use a mild cleanser followed by a light moisturizer to protect the skin each morning,” Lio advises.

Sun care is key, too. Make sure to protect yourself by wearing SPF every day. “It could be an oil-free facial lotion with SPF 30 that you can use daily,” Chien says.

Avoid going back to using products that irritated you before you developed the rash.

“These seem to be generally helpful for many patients, but the truth is that we don’t fully understand why this condition develops, despite many theories,” Lio says.

Still, it is important not to resume the medication unless directed by your healthcare provider. Over time and with appropriate treatment, the rash usually improves.

“Perioral dermatitis is generally thought to be benign and is usually self-limited, although it can be uncomfortable, unsightly, and can persist for many months in some cases, and even years for some patients,” Lio says.

There isn’t any hard data on the number of people living with perioral dermatitis, but dermatologists report it is relatively common.

Perioral dermatitis is seen more frequently in fair-skinned people than in those with darker skin. But Chien adds another caveat: “Rashes, inflammation, and redness on the skin are more difficult to appreciate in African American skin, so sometimes the diagnosis may be missed in that population,” she says.

Perioral dermatitis has also been reported in children, with no significant difference seen in gender or race among kids.

“Clinically, perioral dermatitis and rosacea look so similar and occur in similar demographics and the two may have an overlap,” Chien says.

Perioral dermatitis may also resemble acne, but there are usually some telltale differences, Chien notes.

“In addition to the red bumps and pimples, which could look a lot like perioral dermatitis, classical acne should have blackheads and whiteheads, which we don’t see with perioral dermatitis, since it is more of a completely inflammatory process,” she says.

Favorite Orgs for Essential Info About Perioral Dermatitis

American Academy of Dermatology (AAD)

The AAD is the largest dermatologic association in the United States, with more than 20,500 member physicians. The website provides a robust number of resources on all skin conditions, including perioral dermatitis. If you’ve just been diagnosed with perioral dermatitis, the AAD offers a helpful guide on how to manage the condition.

National Rosacea Society

The National Rosacea Society is a nonprofit with the goal of improving people’s lives with rosacea by raising awareness about the skin condition and supporting medical research into the disorder. Because perioral dermatitis and rosacea tend to overlap if you have both conditions, check out this website for information on symptoms, triggers, and how to manage unruly skin.

Favorite Bloggers Writing About Perioral Dermatitis

Whoorl

Sarah James is a clean beauty blogger based in Oklahoma. In one blog post, she details her journey with perioral dermatitis, which she experienced for the first time at age 45. Complete with before-and-after photos, her blog details what helped her get the condition under control, including a pared-down skin-care routine and stress management.

Girl Gone Green

Suzi is a former organic hairstylist who is now a full-time green beauty blogger who is devoted to examining the ingredients in skin-care and beauty products. On her blog, she shares her battle with perioral dermatitis and offers solutions for how she treated her condition naturally.

Favorite Skin Health Apps

Aysa

Aysa draws on the experience of more than 47,000 physicians and nurses to provide guidance on what to do about your skin woes. Simply snap a picture of the affected area and enter your age and symptoms, and the app will generate potential matches. You can select which skin condition most closely resembles yours and get information on next steps. Aysa, which is available on Android and iOS, can also help you find a doctor close to you if you need to make an appointment.

First Derm

This telemedicine app connects you directly with a board-certified dermatologist from the comfort of your own home. First, you take a couple of pictures of the affected area of your skin, upload them along with some personal details to the app, and a dermatologist will review. You will then receive personalized expert recommendations on possible treatment options, with fees based on response times.