A red, bumpy rash around your mouth can be frustrating, especially when it looks like acne or does not improve with your usual skin care routine. If the rash keeps coming back, it may be perioral dermatitis.
Perioral dermatitis can have several triggers, and the cause is not always easy to identify. Learning what can worsen a flare, what you can safely do at home and when to see a dermatologist can help you find the right treatment.
What Is Perioral Dermatitis?
Perioral dermatitis is an inflammatory skin condition that causes small red, pink or skin-colored bumps around the mouth. The rash may also spread around the nose or eyes. Some people have dry, flaky skin, itching, burning or irritation.
The condition is sometimes called periorificial dermatitis because it can appear around several openings of the face, not just the mouth.
Perioral dermatitis can look similar to acne, rosacea or other skin conditions. A board-certified dermatologist can often diagnose perioral dermatitis by examining your skin and asking about your symptoms, medications and skin care routine. Additional testing may be needed if the diagnosis is unclear.
Perioral dermatitis is not contagious, so it cannot spread from person to person through skin-to-skin contact.
Common Causes & Triggers
The exact cause of perioral dermatitis is not fully understood. However, some factors can irritate the skin or contribute to a flare.
The strongest known association is with topical corticosteroids, such as hydrocortisone creams, used on the face. Skin care products, cosmetics and other irritants may also contribute in some people.
Identifying what may be triggering your inflammation can be an important part of managing perioral dermatitis symptoms.
Topical Steroid Use
Topical corticosteroids are strongly associated with perioral dermatitis. These medications can temporarily reduce redness and irritation, which may make the rash seem better at first. However, continued use can cause the condition to worsen or return after the medication is stopped.
If you use a prescription corticosteroid on your face, do not stop it without talking with the clinician who prescribed it. A dermatologist can help determine whether the medication may be contributing to your rash and how it should be managed.
Cosmetic & Skin Care Products
Skin care and cosmetic products can sometimes irritate sensitive skin or contribute to perioral dermatitis. Heavy or irritating products may be especially troublesome when applied around the mouth.
During a flare, simplifying your routine may help reduce irritation. Your dermatologist may recommend avoiding:
- Heavy creams or ointments
- Makeup around the affected area
- Fragranced products
- Products that cause burning or stinging
For more information about choosing products and caring for your skin, explore Goodskin’s skin care education resources.
Toothpaste may also irritate the skin around the mouth in some people. High-fluoride toothpaste has been reported as a possible trigger, although this does not mean that everyone with the condition needs to stop using fluoride toothpaste. If you suspect your toothpaste is contributing to your symptoms, consult your dermatologist and dentist before making a change.
Hormonal Factors
Hormonal changes may affect perioral dermatitis in some people. Some patients notice that their symptoms change around their menstrual cycle, pregnancy or when starting or stopping hormonal birth control.
However, hormones are not considered an established single cause of perioral dermatitis. If you notice that your rash follows a pattern, tell your dermatologist, as it may help identify possible triggers.
Symptoms to Watch For
Perioral dermatitis often appears as small bumps around the mouth, nose or eyes. The bumps may be red, pink or skin-colored, depending on your skin tone.
Other symptoms may include:
- Dry or flaky skin
- Itching
- Burning or irritation
- Small pus-filled bumps
- A rash that comes and goes
The skin directly next to the lips may remain clear, creating a narrow band between the rash and the lip line.
Because several skin conditions can look similar, persistent or recurring bumps around the mouth are worth having evaluated rather than repeatedly treating as acne.
Perioral Dermatitis Self-Care: What Helps and What to Avoid
There is no single home remedy that works for everyone with perioral dermatitis.
However, simplifying your skin care routine and avoiding potential triggers may help some people. Other cases require prescription treatment.
A gentler approach to skin care may include:
- Washing your face gently with a mild cleanser
- Using fragrance-free skin care products when appropriate
- Avoiding products that burn, sting or irritate your skin
- Limiting makeup on the affected area during a flare
- Avoiding unnecessary topical corticosteroids
This approach is sometimes called “zero therapy.” It means stopping potential irritants and unnecessary products while the skin recovers. It may help some people, but it is not a substitute for medical treatment when the rash is persistent or severe.
Be cautious with online home remedies that promise to clear perioral dermatitis quickly. Essential oils, harsh exfoliants and other irritating ingredients can make sensitive skin feel worse.
If your rash continues despite simplifying your routine, or if you are unsure whether it is perioral dermatitis, a dermatologist can help determine the cause and recommend appropriate treatment.
Clinical Treatment Options at Goodskin
When self-care is not enough, prescription treatment may help control perioral dermatitis and reduce ongoing flares. At Goodskin, a board-certified dermatologist can examine your skin, review your medical and skin care history and determine whether another condition could be causing similar symptoms.
Treatment usually focuses on identifying and avoiding triggers while treating the inflammation.
Depending on your symptoms, your dermatologist may recommend:
- Stopping or changing a topical corticosteroid when appropriate
- Simplifying your skin care routine
- A prescription topical medication
- An oral antibiotic for more persistent or extensive cases
- Follow-up visits to monitor your response to treatment
Oral tetracycline antibiotics have been studied extensively for perioral dermatitis, while several topical medications may also be used. The best option depends on the individual patient and should be determined by a dermatologist.
Treatment does not always work overnight. Perioral dermatitis can take several weeks or even a few months to clear completely, according to the American Academy of Dermatology.
Frequently Asked Questions
Is perioral dermatitis contagious?
No. Perioral dermatitis is not contagious. You cannot catch it from another person or spread it through skin-to-skin contact.
Can stopping steroid creams cause a flare?
Yes. If a topical corticosteroid has been contributing to perioral dermatitis, the rash may become more noticeable after the medication is stopped. This temporary worsening can make it tempting to start using the steroid again, but that may continue the cycle.
If you use a prescription corticosteroid, talk with the clinician who prescribed it before stopping the medication. A dermatologist can help you determine the safest way to manage the rash.
How long does perioral dermatitis take to clear up?
Perioral dermatitis usually improves gradually rather than overnight. Some people begin to see improvement within several weeks, while complete clearing may take a few months. The timeline depends on factors such as the severity of the condition, potential triggers and the treatment recommended by your dermatologist.
Schedule a Consultation
When a rash around your mouth keeps coming back, it can be frustrating to keep trying different products without knowing what is causing it. An accurate diagnosis can help you move from guessing to a treatment approach that fits your skin.
Goodskin Dermatology offers Medical Dermatology at four Portland-area locations: Clackamas, Troutdale, Beaverton and Hillsboro.
Schedule a consultation for a professional evaluation and a treatment plan tailored to your skin.
