All Things Perioral Dermatitis

What is perioral dermatitis?

Perioral dermatitis (POD) is an inflammatory rash involving the skin in the perioral region around the mouth and nose. The rash may spread up to the nose or even the eyes, in more severe cases. It usually appears as a scaly or red bumpy rash around the mouth. There may be a clear fluid discharge, redness, and slight itching or burning can also occur.

Perioral dermatitis is more common than you would think and I see this a lot in my practice. It usually self resolves, but in more severe cases it may require dermatologic intervention. Episodes of perioral dermatitis can last weeks and even months.

What causes perioral dermatitis?

It is hard to pinpoint what causes a flare up. A lot of times it can be linked to stress, hormones, climate, or even diet. The exact cause of perioral dermatitis is unknown and can differ from person to person. There really is no way to fully prevent this from occurring. We do know that it is not contagious. This is a skin condition that usually lies dormant in the skin until it is triggered by one of the following:

• Hormone Changes
• Pregnancy
• Birth Control
• bacterial or fungal infection
• Constant drooling
• Fluorinated toothpaste
• Sunscreen
• Rosacea
• Steroid use
• Excessive exposure to heat, sun, or wind 

It is without question that our diet affects our skin. Our skin is actually our largest organ, and if it’s presenting blemishes, rashes or discoloration, it is often a result of something being “off” in our gut. If we eat foods that we may be intolerant to, or foods that are toxic to our body, they can actually ruin the lining of our intestine. If the lining of the intestine is compromised, then particles from our food may get into our bloodstream and cause irritation and inflammation which can show up as skin problems. Crazy right?!  A lot of times these flare ups stem from gut health, so I also like to recommend an amazing Greens supplement.

What are the symptoms of perioral dermatitis?

Perioral dermatitis usually appears as a rash of red bumps around the mouth and in the folds around the nose. The bumps may be scaly in appearance and can contain pus or fluids. You may experience symptoms such as burning or itching, especially as the rash worsens. 

Typically, when I see a case of POD the patients first mistakes it as acne – they do look very similar at times.

How is perioral dermatitis diagnosed?

I can usually spot this during my online skin consults. Your doctor or dermatologist can often diagnose perioral dermatitis with just a visual examination of your skin, along with your medical history.

Your doctor may also perform a skin culture to rule out a possible infection. During this test, your doctor will swab a small patch of skin in the affected area. They’ll send the sample to a laboratory to test the skin cells for bacteria or fungi. 

What are the treatment options for perioral dermatitis?

The best policy is to leave the areas where POD is present and flared open and dry to air. Stop any and all skincare in the affected area. It can take several days to weeks to heal. Once it is healed, we will be able to use skincare on the affected area again. The less you bother it, the better. 

If you have been using products around it, I would leave it open to air as much as possible and I would only cleanse around the area. Using the products on the rest of your face is totally fine – just avoid the active areas for at least 2 weeks or until healed. Do not try to pop the affected areas!

Perioral dermatitis is difficult to treat and can last for months. The condition can get worse before it improves and in many, perioral dermatitis may become chronic.

Skincare Tips

Switch to gentle cleansers and moisturizers. Avoid using exfoliants in the affected area. When you use exfoliating pads (or any products with exfoliants and/or acids in them), you want to avoid using them in the areas where you are experiencing perioral dermatitis. It is OK to continue using these products on other parts of the face. Sometimes this just involves a little trial and error, as each patient’s experience with POD is unique and different. 

Prescription medications 

Medications your dermatologist may prescribe to treat your condition include:

• Topical antibiotic medications, such as Metro gel and Erythromycin
• Immunosuppressive creams, such as Pimecrolimus or Tacrolimus cream
• Topical acne meds, such as Adapalene or Azelaic acid
• Oral antibiotics, such as Doxycycline, Tetracycline, Minocycline, or Isotretinoin, for more severe cases
• Avoid steroid creams and ointments unless specifically directed by your doctor. If another medical practitioner prescribes a topical steroid, make sure to let them know you have perioral dermatitis. In general, it’s more likely to occur with stronger topical steroids than weaker ones. 

Top tips for POD

• No fluoride in toothpaste
• Opti Greens 50, Full Mega, Probiotics
• Journal foods to figure out dietary triggers – GUT HEALTH = SKIN HEALTH 
• Stress/weather
• Limit overly salty or spicy foods. They can irritate skin around the mouth.
• Frequently wash your pillowcase & towels in hot water 
• Stop using or reduce your use of makeup, cosmetics, and sunscreen. 
• No acids on POD …only gentle products and LOTS of hydration

Online Skin Care Consults 

I’m always here to help! I know how disheartening acne and skin conditions can be. I see it first hand and it breaks my heart when someone is lacking confidence because of it. If you are suffering, you are not alone and you do not have to live with skin you are not comfortable in! We can improve your skin with the right products and approach. I just recently had a patient tell me that she “truly never thought it was possible to love her skin, and now she loves seeing her face in mirrors and feels confident to face anything and anyone!

Perioral Dermatitis waxes and wanes, but with proper skin care, diet, and supplements, we can usually keep it at bay! If you think you have experienced POD or you are experiencing it now, we can try to work through it together!

XO

Racquel