What You Need to Know About Perioral Dermatitis, an Annoying Red Face Rash
The words “perioral dermatitis” might sound a little foreboding, which is actually pretty fitting. Perioral dermatitis can cause an angry red rash to bloom around your mouth, seemingly out of nowhere, as if by terrible dermatological magic. To add insult to injury, it can be really hard to even figure out what the heck is going on because it’s all too easy to confuse perioral dermatitis, which causes tiny red bumps to form on the lower half of your face, with other skin conditions. Here’s how to tell the difference—plus what you should do if perioral dermatitis actually is your issue.
A few distinct symptoms can clue you in to the fact that you’re struggling with perioral dermatitis, like it showing up mostly around your mouth.
You’ve probably never heard of perioral dermatitis before, and that’s understandable. It’s pretty much a nobody compared to more well-known conditions like eczema and acne. So no one would blame you for assuming that’s what you’re dealing with, but perioral dermatitis is slightly different.
This rash of small bumps is usually red in people with light skin and flesh-colored in people of color, according to the American Academy of Dermatology (AAD). It typically causes dry, flaky skin, and may also come with itching, hence why it’s often confused with eczema.
Eczema can manifest as a dry, itchy rash made up of red or brownish-gray patches, thickened, cracked, scaly skin, or small raised bumps that leak liquid and crust over when you scratch them. But eczema isn’t likely to cause burning, while perioral dermatitis can. Eczema can also show up anywhere on your body (including your scalp), but it’s most likely to be on your hands, feet, ankles, wrists, neck, upper chest, eyelids, and inside the crooks of your elbows and knees, according to the Mayo Clinic. Perioral dermatitis usually appears around the mouth and in the folds of skin around your nose, though it can sometimes appear around your eyes and even around your genitals.
No matter where it is, perioral dermatitis might start in a pretty localized spot, like the corners of your lips, then spread from there, Cynthia Bailey, M.D., a diplomate of the American Board of Dermatology and president and CEO of Advanced Skin Care and Dermatology Inc., tells SELF.
Also, while the bumps in your perioral dermatitis rash may be filled with fluid or pus, they typically don’t come to a pale, ready-to-burst head the way acne often does, Gary Goldenberg, M.D., an assistant clinical professor of dermatology at the Icahn School of Medicine at Mount Sinai, tells SELF. Instead, if the bumps contain any liquid, the fluid is more likely to be evenly spread throughout, the way it is in a blister.
Doctors aren’t totally sure why some people develop perioral dermatitis, but it’s often associated with using corticosteroid creams.
Many people with perioral dermatitis get it when they use a corticosteroid medication on the area for too long, the AAD says. Corticosteroids tamp down on inflammation, so they’re used to treat everything from eczema to angular cheilitis (painful little cracks at the corners of your mouth)—basically anything that’s rooted in inflamed skin. But exposing your skin to them for too long can clearly have repercussions. Whether you’re using an over-the-counter or prescription corticosteroid medication, following the instructions is key.
Though corticosteroids are the main culprit here, a wide range of things that irritate your skin can cause perioral dermatitis, Joshua Zeichner, M.D., a New York City-based board-certified dermatologist, tells SELF. That could be your skincare products, toothpaste, and allergens that upset your skin, the AAD says.
If you wind up with perioral dermatitis after applying a corticosteroid cream, you should either stop using it immediately or consult your doctor ASAP.
It depends on if you’re using an over-the-counter corticosteroid you chose yourself or if you’re using one your doctor prescribed. If it’s the former, you should stop using it right away. If it’s the latter, consult your doctor as quickly as you can to see if you can stop using it, the AAD says.
As a heads up, the rash can get worse when you first stop applying the corticosteroid. Even if it’s causing your perioral dermatitis, it still might be combating unrelated inflammation in the area, so that can bounce back with a vengeance for a bit. You’ll probably be tempted to start using the corticosteroid again, but don’t—that will only give you temporary relief, the AAD says, and even that’s not a guarantee. Then, every time you stop using it, you might experience a perioral dermatitis flare-up.
Every case of perioral dermatitis is different, which is why it’s so important to see your dermatologist ASAP for help treating it, no matter the cause, Dr. Bailey says. If it’s not diagnosed and treated early, the bumps can become deeper and more stubborn, she says.
To deal with perioral dermatitis, your dermatologist will likely prescribe an oral antibiotic, figure out if you need to treat any inflammation you were potentially targeting with corticosteroids, and advise you on how to baby your skin so it can get better. Your skincare regimen is extremely important in this time—the last thing you want to do is douse your healing skin in harsh chemicals.
The AAD specifically recommends that you switch to a mild, fragrance-free cleanser if you’re not using one already, and be extra gentle when you wash your face. You may also need to use gentle, fragrance-free skincare products. Whatever you do, avoid these potentially irritating ingredients, and check out these products that are often great for sensitive skin. Be sure to ask your doctor for recommendations if you’re at all unsure about what you should use.
Unfortunately, perioral dermatitis doesn’t just go away overnight, even with treatment. Instead, it usually clears out slowly and can take a few weeks up to a few months to completely go away, the AAD says.
There is some good news, though, according to Dr. Zeichner: In most cases, as long as you avoid whatever caused your perioral dermatitis, that red rash around your mouth should be gone for good.
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