What does perioral dermatitis look like?

Perioral dermatitis often causes clusters of small bumps. The affected skin may be:

Red, pink, brown or otherwise discolored
Dry or flaky
Rough
Itchy
Tender
Burning or stinging

Some bumps contain clear fluid or pus. The rash frequently forms around the mouth while leaving a narrow area directly next to the lips unaffected.

It can also develop:

Beside the nose
Around the eyes
On the eyelids
On the cheeks
On the chin

Unlike acne, perioral dermatitis usually does not cause blackheads or deep cysts.

What causes perioral dermatitis?

The exact cause is not always clear. Topical corticosteroid use is a frequent trigger, including over-the-counter hydrocortisone.

Other possible contributors include:

Prescription steroid creams
Steroid inhalers or nasal sprays
Heavy facial creams
Certain cosmetics
Irritating skin care products
Hormonal changes
Fluoridated or strongly flavored oral-care products
Heat, wind or ultraviolet exposure

A trigger may not be identifiable in every patient.

How is perioral dermatitis diagnosed?

A dermatologist can often diagnose the condition by examining the rash and reviewing the products and medications used on the face.

Testing is not usually necessary. A skin scraping, culture, patch test or biopsy may occasionally be performed to exclude fungal infection, bacterial folliculitis, allergic contact dermatitis or another inflammatory condition.

Why can steroid cream make the rash worse?

A corticosteroid may temporarily reduce redness, making the rash appear better. However, continued use can allow perioral dermatitis to persist or become more extensive.

The rash may flare when the steroid is discontinued. This rebound does not necessarily mean the medication should be restarted.

Do not abruptly stop a prescription steroid that your healthcare provider has instructed you to use. Ask the prescribing provider how it should be discontinued or replaced.

How is perioral dermatitis treated?

Treatment may include:

Discontinuing topical corticosteroids under medical guidance
Simplifying the skin care routine
Using a gentle cleanser
Avoiding heavy or irritating facial products
Topical antibiotic or anti-inflammatory medication
An oral antibiotic for more widespread or persistent disease

Improvement is gradual and may require several weeks or months. Using treatment consistently is important even when the rash does not clear immediately.

Schedule a perioral dermatitis consultation

A rash around the mouth or eyes should not automatically be treated with hydrocortisone. The Dermatology Clinic can confirm the diagnosis, identify possible triggers and develop a plan to clear the rash while minimizing recurrence. Contact us today to get scheduled.