Why does it feel like right when a skin care routine seems to be working its magic, an errant breakout sends you back to running damage control? Usually, you can blame a flareup on the monthly onset of hormones or that one night you “forgot” to remove your makeup. But, if you’re like me, you may have experienced a bout of skin rebellion that didn’t quite look like your regular row, evaded your typical mode of attack, and seemed to hang around longer than normal. If this sounds familiar, you may be dealing with perioral dermatitis.
“Perioral dermatitis presents with small, inflammatory, flesh-colored bumps and scaly patches around the mouth that often resemble acne or rosacea,” says board certified dermatologist and skin of color advocate Dr. Adeline Kikam, DO, MS, FAAD. “On darker skin, this may present with a dark or bluish hue and underlying post-inflammatory hyperpigmentation.” The condition is best described as a persistent rash and while it is extremely common, is most often seen in young, adult women. The condition is also characterized by redness, irritation, and dryness largely caused by a damaged moisture barrier. (As a reminder, the skin barrier is the waterproof, upper layer of skin cells responsible for maintaining optimal hydration levels and repelling bacteria. It is critical to skin’s normal functioning and can take extended periods of time to repair once compromise.)
Contrary to its name, perioral dermatitis can also occur around the nose, eyes, and sometimes even the forehead and cheeks, making it difficult to recognize. “The clinical differences between perioral dermatitis, acne, eczema, and other rashes are subtle,” says board certified dermatologist Dr. Arash Akhavan. Licensed esthetician Ashley White adds that perioral dermatitis is often mistaken for acne, and “treating it as such only aggravates the condition further and can possibly cause it to spread.” Discerning between acne and perioral dermatitis can be tricky and is best left to a medical professional. However, some specific warning signs of perioral dermatitis are itching, burning, and sensitivity to skin care products.
What Causes Perioral Dermatitis?
While the exact cause is unknown, preexisting skin conditions play a contributing role in perioral dermatitis. “Those genetically at risk for eczema seem to have a slightly higher propensity for perioral dermatitis,” says Dr. Akhavan. “Exposure to irritants, allergens, and medications such as topical steroids also seem to be a cause.”
Any combination of irritating internal and external factors (including extreme cold or heat) can trigger a perioral dermatitis flare, but there are specific products and habits that are known to create more issues. Board-certified plastic surgeon Dr. Kevin Sadati cites over-exfoliation, fluoride toothpaste, retinoids, overuse of products, and rosacea as potential aggravators.
Above all, topical steroid use poses the greatest threat for developing perioral dermatitis. Ironically, steroids are commonly prescribed to treat skin irritations like eczema and other rashes, but are meant to be applied in moderation. Their ability to quickly quell inflammation and accessibility in every drugstore’s health section make them a commonly overused remedy.
“[Steroids] have other deleterious effects when used on the face such as skin thinning leading to wrinkles, broken blood vessels, and formation of acne,” warns Dr. Akhavan. “Only very mild steroids should be used on the face and for no more than a few days at most.”
How To Treat Perioral Dermatitis
While the first treatment step for perioral dermatitis involves discontinuing steroid use, Dr. Kikam notes that individuals who have been applying topical steroids for prolonged periods of time must be weaned off to avoid other withdrawal symptoms like burning, redness, and peeling.
Once you’ve done away with steroids, the next step is to completely strip down your skin care routine as many products, particularly strong exfoliants, are a common trigger for perioral dermatitis. Fragrances, dyes, essential oils, and active ingredients (like acids and retinoids) can further exacerbate irritation and increase discomfort.
Opting for gentle, soothing, and hydrating products will help nurse your skin’s barrier back to health. “I recommend using moisturizers with ceramides [waxy lipids that protect and moisturize skin], to replenish the moisture barrier and niacinamide to calm skin,” advises Dr. Kikam. “Less is more,” adds Dr. Sadati. “Use gentle cleansers and avoid putting any additional product over [the area]. Do not touch the area, either. Protect the rash from the sun, exposing it to UV rays can make it worse.”
Perioral dermatitis is likely to resolve itself within weeks, but there are some cases where vestiges of the condition can stick around for many months or years. In more severe, stubborn cases prescription topical and oral medication can help accelerate healing time. Topical treatments may include an anti-mite treatment with ivermectin or antibiotics like erythromycin and metronidazole. Oral antibiotics such as doxycycline are also commonly prescribed. “The anti-inflammatory activity of topical and oral antibiotics, rather than their antimicrobial activity, seem to improve the condition,” explains Dr. Akhavan.
Be Patient With Your Skin
Even when employing every treatment technique it may take several months for the inflammation to fully subside — but be sure to stay diligent! It’s also important to keep practicing healthy skin habits after remission and identify potential triggers as the condition is likely to recur otherwise. “Once cured, reintroduce one single skin care product every two weeks, taking care to closely monitor skin's response,” advises Dr. Akhavan.
Overall, the best thing you can do for your skin is see a professional quickly. “Honestly, don't guess and see a dermatologist right away to get a proper diagnosis and topical medications if needed,” advises White. “The sooner it's identified, the less likely it will spread and the faster you can begin to heal.”
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