What Is Perioral Dermatitis?

Perioral dermatitis is a skin condition characterized by a rash around the mouth. It is one type of dermatitis, which is a general term for skin irritation. In the word “perioral,” “peri” means “around" and “oral” refers to the mouth.

“You might be thinking, ‘What’s that on her face?’” Seyfried says, explaining that the rash first appeared when she was 19.

Two years ago, she says, she had another flare-up and decided to cut out dairy to see if that helped. “Bye-bye cappuccino,” she laments.

Later in the video she explains that her skin has gotten better over the past 20 years, especially after she had children, but she still requires medication. “This, don’t worry,” she says, pointing at the redness over her upper lip. “I’m using this medicated cream for this little cutie mustache.”

People with perioral dermatitis have a visible rash around their mouth, says Peter Lio, MD, a dermatologist at Northwestern Memorial Hospital in Chicago.

“Typically, it would present as small red papules, or bumps, around the mouth and sometimes nose and eye areas,” he says. “Unlike mild irritation in these areas, this rash persists for weeks and beyond.”

Additionally, perioral dermatitis is often associated with redness and scaling, says Arielle Nagler, MD, a dermatologist at NYU Langone Health in New York City.

“Patients often complain of itching and burning,” she says. “Since certain topicals can exacerbate perioral dermatitis and treatments are all by prescription, medical care is recommended.”

“Using steroids around the mouth — including inhaled steroids for asthma — is a common trigger in children,” Dr. Lio says.

During the COVID-19 pandemic, dermatologists saw a rise in perioral dermatitis as a result of face masks. Anna Lien-Lun Chien, MD, an associate professor of dermatology at Johns Hopkins University School of Medicine in Baltimore, said her practice noted an increase in cases during the pandemic.

“Unfortunately with the mask in place, it creates a different environment,” she says. “It changes the barrier of the skin in that area. Especially for an individual who’s more sensitive or prone to this inflammation, they can start developing those breakouts.”

In some cases of perioral dermatitis, a skin-care product or even a particular toothpaste may be the culprit, Lio says.

The skin condition can affect anyone at any age, but children and women are most affected, Lio says.

“Any new rash is potentially worth seeking medical care for, but especially more severe and persistent rashes would warrant reaching out,” Lio says. “While there are not too many concerning things that can mimic this, sometimes bacterial or viral infections can be similar, and those should be promptly diagnosed and treated.”

He notes that most patients will first see their primary care doctor, but if the rash is not responding to treatment or the diagnosis is unclear, a visit to a board-certified dermatologist can be helpful.

“There is not a lot of data on recurrence after resolution; however, in my experience recurrences are common and can even occur years after successful treatment,” Dr. Nagler says.

There is no specific FDA-approved treatment for perioral dermatitis, Lio says. Sometimes it may clear up on its own. Yet some people will need the help of a healthcare provider. There are several approaches you can take to relieve symptoms.

For cases that don’t respond to these practical steps, dermatologists will typically treat perioral dermatitis in a similar way to rosacea, Lio says.

“The first-line treatment is a topical therapy that we might use for rosacea: metronidazole (Flagyl) cream or ivermectin (Stromectol) cream, usually applied twice daily,” he says. “Sometimes I will add in a sulfur-based cleanser as well.”

If that doesn’t work or if the condition is severe, oral antibiotics like doxycycline may be prescribed to manage inflammatory issues, Lio says.

“In children, sometimes we will use azithromycin or erythromycin instead,” he says. “Usually, a few weeks of these anti-inflammatory antibiotics seems to break the cycle.”

Prevention of Perioral Dermatitis

Keep your skin-care routine simple. “Use a mild cleanser followed by a light moisturizer to protect the skin each morning,” Lio advises.

Sun care is key, too. Make sure to protect yourself by wearing SPF every day. “It could be an oil-free facial lotion with SPF 30 that you can use daily,” Dr. Chien says.

Avoid going back to using products that irritated you before you developed the rash.

“These seem to be generally helpful for many patients, but the truth is that we don’t fully understand why this condition develops, despite many theories,” Chien says.

Still, it’s important not to resume the medication unless directed by your healthcare provider. Over time and with appropriate treatment, the rash usually improves.

“Perioral dermatitis is generally thought to be benign and is usually self-limited, although it can be uncomfortable, unsightly, and can persist for many months in some cases, and even years for some patients,” Lio says.

There isn’t any hard data on the number of people living with perioral dermatitis, but dermatologists report it is relatively common.

Perioral dermatitis is seen more frequently in fair-skinned people than in those with darker skin. But Chien adds another caveat: “Rashes, inflammation, and redness on the skin are more difficult to appreciate in African American skin, so sometimes the diagnosis may be missed in that population,” she says.

Perioral dermatitis has also been reported in children, with no significant difference seen in gender or race among kids.

“Clinically, perioral dermatitis and rosacea look so similar and occur in similar demographics and the two may have an overlap,” Chien says.

Perioral dermatitis may also resemble acne, but there are usually some telltale differences, Chien notes.

“In addition to the red bumps and pimples, which could look a lot like perioral dermatitis, classical acne should have blackheads and whiteheads, which we don’t see with perioral dermatitis, since it is more of a completely inflammatory process,” she says.

• Perioral dermatitis is a skin condition characterized by a red rash around the mouth that can resemble acne but requires different treatment.
• Often triggered by topical steroids, the wearing of face masks, or certain skin-care products, its symptoms can persist for weeks or longer.
• If you have a persistent rash, see a doctor for a diagnosis and personalized treatment.