Perioral and periorificial dermatitis

Skin rashes can be hard to tell apart, even for doctors. Sometimes an exact diagnosis doesn’t matter much, because many rashes respond to the same approach. Periorificial dermatitis (PD) is the exception. It mimics acne and eczema, and quickly gets worse when it’s treated as one of them.

What it is

Around 1 in 100 people have an episode each year. The rash usually shows up as groups of small red bumps on irritated skin, which may itch or feel tender. Skin often burns or tingles with even the blandest products, and tiny pus spots can appear over time.

We call it ‘periorificial’ because it develops around the mouth, nostrils and eyes (perioral, perinasal or periocular when it’s in one area). It usually spares the cheeks, forehead and the narrow strip of skin right around the lips, which creates a tell-tale pattern.

We don’t yet fully understand why it happens. Likely contributors include a weakened skin barrier, an over-active immune response in the skin, an imbalance in the skin’s microbes, hormonal changes, and reactions to things put on the skin, such as steroid creams, make-up, skincare and sunscreen.

Why diagnosis matters

Because it looks so varied, PD is often misdiagnosed as contact dermatitis, eczema, acne, rosacea or seborrhoeic dermatitis. That’s a problem, because common treatments for those conditions can make PD worse.

Steroid creams are the classic example. They calm the rash for a few days, then it flares harder once they’re stopped. Some people go through this cycle several times, so the rash is severe by the time the right approach begins.

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What helps

PD responds best to a ‘less is more’ approach.

• Strip back your skincare to a simple, bland routine.
• Remove likely triggers, such as essential oils, fragrance, frequent or strong exfoliants, and products with long lists of actives. Sometimes even retinoids need a break.
• Support the skin barrier with gentle products suited to how your skin is right now.

For some people, this is enough. Others need prescription treatment, which may include creams that calm inflammation in the skin, a low-dose oral antibiotic, or both. Which option suits you depends on your overall health and how severe the rash is. Each has its own possible side effects, so it’s a decision for you and your doctor.

Why early care matters

PD can be stubborn. Care often takes three to four months, sometimes continuing after the rash clears to stop it coming back. In general, the sooner the right approach starts, the sooner it settles.

If this all sounds complicated, the most important things are an accurate diagnosis, the right care early, and support on hand while your skin recovers.

References

1. Tempark T, Shwayder TA. Perioral dermatitis: a review of the condition with special attention to treatment options. Am J Clin Dermatol. 2014;15(2):101-13.
2. Balić A, Vlašić D, Mokos M, Marinović B. The role of the skin barrier in periorificial dermatitis. Acta Dermatovenerol Croat. 2019;27(3):190-7.
3. Ollech A, Yousif R, Kruse L, et al. Topical calcineurin inhibitors for pediatric periorificial dermatitis. J Am Acad Dermatol. 2020;82(6):1409-14.
4. Tolaymat L, Hall MR. Perioral dermatitis. StatPearls. 2021.
5. Lee H, Kim KH. Treatment of pediatric periorificial dermatitis with topical calcineurin inhibitor and topical/oral metronidazole. J Dermatol. 2021;48(2):203-9.

This article is general information only. It isn’t a substitute for personal medical advice, so speak with a health professional about your own skin.