What Is Perioral Dermatitis? Dermatologists Explain What You Need to Know

If you've recently taken a look in the mirror and have noticed a suspicious breakout around your mouth, you might have assumed it's a hormonal acne breakout and busted out your acne-fighting skincare. But instead of the breakout calming down, it's actually creeping up around your nose and maybe even your eyes. Before you freak out—it's probably perioral dermatitis.

"Perioral dermatitis is frequently mistaken for acne," board-certified dermatologist Blair Murphy-Rose, MD, FAAD, explains. Read on to learn how to distinguish perioral dermatitis, what it is, how to prevent it, and how to treat it.

What Is Perioral Dermatitis?

“Perioral dermatitis is an inflammatory skin condition of the face,” says Dr. Jodi LoGerfo, DNP, APRN, FNP-C, DCNP, a dermatologist with the Orentreich Medical Group in New York City. “It mostly affects young women. Those who usually have perioral dermatitis have small, inflammatory, red papules and/or pustules with or without scaling. It occurs around the mouth, chin, nose, or eyes. When it occurs around the mouth, the skin next to the border of the lip is commonly clear.”

Sometimes perioral dermatitis can cause burning or itching, but it’s most often asymptomatic, adds Dr. Murphy-Rose. It usually occurs in women ages 20 to 40.

What Causes Perioral Dermatitis?

"There have been lots of theories as to what causes perioral dermatitis, but the cause is not so understood," Dr. LoGerfo says. "One of the largest contributors to the condition is topical corticosteroid use."

Perioral dermatitis has also been associated with external hormones—such as oral contraceptives and IUDs, fluorinated toothpaste, and fluorinated steroids (like those in creams or inhalers), explains Dr. Murphy-Rose.

How to Treat Perioral Dermatitis

"Perioral dermatitis is best treated under the care of a board-certified dermatologist," Dr. Murphy-Rose says. "For many cases, I treat perioral dermatitis with a prescription cream and oral medication."

The most essential part of treatment is discontinuing topical corticosteroids—if patients are using them—on the face, according to Dr. LoGerfo. "We usually treat perioral dermatitis with medications that are called topical calcineurin inhibitors," she says. "Topical calcineurin inhibitors (TCI) are a newer class of drugs we use in dermatology. There are two drugs in this class: tacrolimus ointment and pimecrolimus cream. Both of these drugs act by inhibiting inflammation in the skin. They are used as an alternative to topical corticosteroids. We often use these drugs along with topical antibiotics such as clindamycin and erythromycin and topical antimicrobial/antibacterial metronidazole. I often combine topical medications with oral antibiotics in the tetracycline family, including tetracycline, minocycline, and doxycycline. Oral tetracyclines have great anti-inflammatory effects, which is helpful in perioral dermatitis."

How to Prevent Perioral Dermatitis

"Perioral dermatitis can be triggered by the use of fluorinated toothpaste and fluorinated steroids (like those in creams or inhalers), so avoiding these can help avoid a flare," Dr. Murphy-Rose says. "The same may apply to the use of birth control, though I hesitate to say this because most people on birth control will not experience perioral dermatitis. Moreover, perioral dermatitis often occurs in the absence of any of these. All this to say, there is often nothing you can do to prevent perioral dermatitis; there is likely some inherent predisposition to its development."

To play it safe, avoiding topical corticosteroids is also best. "One of the most consequential tools in managing the disease is this," Dr. LoGerfo says. "Another major factor is to practice gentle skincare and minimize using potential skin irritants and allergens. This involves gently cleansing the skin. I usually recommend using something like Cetaphil."  

How Long Does It Take for Perioral Dermatitis to Go Away?

With prescription therapy, Dr. Murphy-Rose says most of her patients see significant improvement within two weeks. However, that’s not always the case.  "It can take weeks to months for perioral dermatitis to resolve," Dr. LoGerfo says. "Generally, I find that with appropriate topical and oral treatments, it takes about two to three weeks to resolve. However, sometimes it can take longer."

When to See a Doctor

"Acne around the mouth and perioral dermatitis can look very similar," Dr. Murphy-Rose says. "I recommend seeing an experienced dermatologist at the first sign of symptoms. However, it is reasonable to treat with over-the-counter acne medications first and assess your response over a few weeks. If you notice unusual involvement (i.e., different from your usual acne) around the nose, lips, or eyes, that would also warrant seeking a dermatologist consultation earlier to get on medication and hasten the resolution of your symptoms."

Perioral Dermatitis vs. Rosacea

Sometimes, people confuse perioral dermatitis with rosacea—both conditions involve red, irritated skin. However, these two skin conditions are not the same. The biggest (and most important) difference is that perioral dermatitis is simply a rash and not considered a chronic condition, while rosacea is a chronic inflammatory condition that is usually triggered by extreme temperatures, stress, sun exposure, and more. And yes, you can actually have both conditions at the same time.

The Final Takeaway

"It is important to know that perioral dermatitis is often stubborn and frequently will not resolve on its own," Dr. Murphy-Rose says. That's why both experts urge you to see a dermatologist once you suspect you have perioral dermatitis. "You should seek professional dermatological help when you have pustules and scaling that does not resolve with over-the-counter treatments," Dr. LoGerfo notes.

Once you are diagnosed with perioral dermatitis, it's essential to follow your doctor's treatment plan and stick to a simple, gentle skincare routine. By doing so, you can usually expect your perioral dermatitis flare-up to resolve within three weeks.