Perioral Dermatitis

Overview

What is perioral (periorificial) dermatitis? What does it look like?

Perioral (periorificial) dermatitis is a red rash that circles your mouth. Your skin can be scaly, dry and flaky with swollen, inflamed bumps called papules. It is one of many types of dermatitis. Perioral dermatitis can look like acne and is often mistaken for it.

Some people report that perioral dermatitis itches or burns. Sometimes it spreads up to the nose and eyes and, very rarely, the genitals.

In the word perioral, “peri” means “around” and “oral” means “mouth.” The word literally means “around the mouth.” In the word periorificial, “orifical” means orifice or “an opening.” “Around an opening” is the meaning of periorificial. The two words refer to the same condition.

What are the types of perioral dermatitis?

There is typical perioral dermatitis, and then there is granulomatous perioral dermatitis. Granulomatous is not a type perioral dermatitis, but an irregular version of it. If you have granulomatous dermatitis then you’ll see yellowish bumps instead of red ones. Children are more prone to have granulomatous dermatitis than adults.

Where does perioral (periorificial) dermatitis most commonly occur?

Perioral dermatitis is easily recognizable by the location of the rash around your mouth. It can also go on your eyelids or around your eyes and nose. Rarely, it will appear on your genitals. Rarer still, it may move to the ears, neck, scalp, trunk and extremities.

Can perioral dermatitis become rosacea?

Perioral dermatitis can return after treatment. This happens even when it was successfully treated. Many cases that return can turn into rosacea, a skin condition that causes red papules in the middle of your face, including on your nose.

Who is at risk of getting perioral dermatitis?

You’re most at risk if you’re a woman between 25 and 45 who uses topical steroids, face creams and more (see the Causes section). However, children and men can develop perioral dermatitis, too.

Is perioral dermatitis contagious?

No. No type of dermatitis is contagious. It can’t be spread to another person.

Is perioral dermatitis a fungal infection?

Overuse of topical steroids is the most likely cause of perioral dermatitis. However, there are a number of theories and the exact cause is yet to be determined. One theory is that perioral dermatitis is caused by candida albicans. Candida albicans is a yeast, which is a type of fungus.

Is perioral dermatitis (periorificial) a bacterial infection?

The exact cause of perioral dermatitis is unknown, but there are many theories. One theory is that this skin condition is caused by follicular fusiform, a type of bacteria.

Symptoms and Causes

What causes perioral dermatitis?

The exact cause is to be determined, but experts have noted 13 possible causes of perioral dermatitis:

Steroids:

  • Topical steroid creams.
  • Inhaled prescription steroid sprays.

Lifestyle choices:

  • Moisturizers and heavy face creams.
  • Fluorinated toothpaste.
  • Gum chewing.
  • Dental fillings.

Other:

  • Hormonal changes (or oral contraceptives).
  • Dysfunction of the epidermal barrier.
  • Problems with the immune system.
  • Altered cutaneous microflora.
  • Bacteria – follicular fusiform.
  • Candida albicans.
  • Demodex mites.

What are the symptoms of perioral dermatitis?

The primary symptom of perioral dermatitis is a red rash around your mouth. The rash may be scaly or dry and flaky. Often there are inflamed bumps that are called papules. Additionally, you may develop vesicles (clear fluid-filled bumps) or pustules (white fluid-filled bumps). Although it is usually found around the mouth, perioral dermatitis can also move to your eyelids, or around your eyes and nose. It can also appear on your genitals, scalp, ears, neck, extremities and trunk.

The rash can cause an itching or burning sensation.

Some people experience conjunctivitis (pink eye) when they have perioral dermatitis. If you have pink eye then your healthcare provider may refer you to an eye doctor (an ophthalmologist).

Can perioral dermatitis be caused by stress?

Yes. Stress can sometimes cause some types of dermatitis.

Does perioral dermatitis hurt?

Sometimes it itches, and sometimes it burns. This is not true for all people.

What aggravates perioral dermatitis?

Triggers for perioral dermatitis may differ for different people. If you continue doing what is causing your personal perioral dermatitis (using topical steroids, etc.) then your condition may worsen.

Do certain foods worsen or improve perioral (periorificial) dermatitis?

No food or drink is known to cause or worsen perioral dermatitis. However, in some cases, chewing gum has been linked to the rash. Work with your healthcare provider to figure out the cause of your perioral dermatitis so that you can avoid that cause in the future – if possible.

Is perioral dermatitis permanent?

Perioral dermatitis may be permanent if you don’t get treatment. Most cases eventually resolve, but this can take weeks to years. If you do get treatment, your symptoms and rash are likely to go away much sooner. However, there is no known reproducible cure for perioral dermatitis. (It might return.)

Diagnosis and Tests

How is perioral dermatitis diagnosed? What tests are done?

A visual examination by your healthcare provider is usually all you’ll need for a diagnosis of perioral dermatitis. Once in a while a skin biopsy is taken to distinguish perioral from other types of dermatitis such as atopic dermatitis (eczema) and contact dermatitis.

What questions might my healthcare provider ask to diagnose perioral (periorificial) dermatitis?

  • Is there a rash somewhere other than your face?
  • How long have you had the rash?
  • Do you use topical steroids?
  • Does your rash itch?
  • Does your rash burn?
  • Do you have any other types of dermatitis or other skin conditions?
  • Do you see a dermatologist?

Management and Treatment

How is perioral dermatitis treated? What medicines help?

First, you must stop using any products that might be causing your perioral dermatitis. Stop the following:

  • Topical and inhaled steroids. This includes both over-the-counter and prescribed steroids. If your healthcare provider has prescribed a steroid, ask if you can switch to a different medication.
  • Face creams, including moisturizers.
  • Cosmetics (makeup).
  • Sunscreen.
  • Fluorinated toothpaste (toothpaste without fluoride can be found at health food stores).
  • Chewing gum.

Your perioral dermatitis might flare up after you stop a topical steroid. Some experts recommend going back on a topical steroid that is not as strong as what you may be using. Discuss this with your healthcare provider. Your perioral dermatitis may get worse before it gets better.

There are several medications that can help your perioral dermatitis. Unfortunately, these medications may not fix the problem for weeks or months. Your healthcare provider may recommend one or more of the following:

Topical (applied to the skin) medications:

  • Erythromycin gel.
  • Clindamycin lotion or gel.
  • Metronidazole cream or gel.
  • Pimecrolimus.
  • Azelaic acid.
  • Sulfur preparations.
  • Tacrolimus ointment.
  • Pimecrolimus.
  • Adapalene.
  • Photodynamic therapy using a 5-aminolevulinic acid as a photosensitizer.

Sometimes oral antibiotics are prescribed. They help with inflammation. Oftentimes, topical medications are used at the same time as the antibiotics.

Oral (by mouth) antibiotic medications:

  • Tetracycline.
  • Doxycycline.
  • Minocycline.
  • Oral erythromycin. (For preadolescents and pregnant women.)
  • Oral low-dose isotretinoin.

Is there a cure for perioral dermatitis?

Perioral dermatitis may be with you for months or even years. There is no cure, but long-term remissions are possible. Sometimes the rash disappears, then reappears. The same treatments that worked the first time are likely to work again.

Are there complications/side effects of treatment?

Your rash might get worse after you stop using a topical steroid. This is normal. Don’t resume using it unless your healthcare provider tells you to do this. The flare-up will fade with time.

Should I see a dermatologist?

You might need the help of a dermatologist if your rash doesn’t disappear after you’ve stopped topical steroids.

How soon after treatment will my symptoms improve?

It may take days, weeks, or months for your symptoms to go away.

Prevention

How can I reduce my risk of perioral (periorificial) dermatitis?

Avoid topical steroids and face creams. See your healthcare provider as soon as possible after you notice symptoms of a rash around your mouth, especially if the rash causes itchiness and burning.

After the rash is gone, only use a mild soap (fragrance-free) or soap substitute when you wash. Don’t go back to using products you used before the rash.

What medicines can I take to possibly prevent perioral dermatitis?

There are no known medicines that can prevent perioral dermatitis, but there are some that can cause it. Topical steroids are the most likely cause of the rash.

What foods can I eat or avoid to reduce my risk of perioral dermatitis?

At this time there are no known foods that can help your perioral dermatitis, or worsen it.

Outlook / Prognosis

What can I expect if I’ve been diagnosed with perioral dermatitis?

Expect that you’ll have to abide by a treatment plan worked out with your healthcare provider. Every treatment plan is different. You might need topical medications or oral medications, or you might simply need to stop doing what’s causing the rash (such as stop taking topical steroids). However, most of the time a treatment regimen that effectively controls the perioral dermatitis can be found.

Remember — your perioral dermatitis will get worse before it gets better when you stop taking topical steroids. This is normal, and expected.

How long will I have perioral (periorificial) dermatitis?

Perioral dermatitis may stay with you for months or even years.

Can perioral dermatitis go away on its own?

This can happen. If you stop all steroids, you might find that the rash and symptoms disappear.

Can perioral dermatitis get worse?

Yes, perioral dermatitis can get worse if you do not follow your healthcare provider’s treatment plan.

Living With

How do I take care of myself?

Once your rash clears, don’t go back to using the steroids, face creams, or other products that possibly caused it.

When you have the rash, just wash with warm water. Don’t use soap until after it’s gone.

Listen to your healthcare provider’s instructions.

When should I see my healthcare provider?

See your healthcare provider as soon as you see a rash or have symptoms of perioral dermatitis. You’ll want to get treatment before the rash and/or symptoms become severe.

What questions should I ask my healthcare provider about perioral (periorificial) dermatitis?

  • Why do I have perioral dermatitis?
  • Do I have perioral dermatitis or another type of dermatitis?
  • Do you think this will go away on its own, or do I need treatment?
  • What medications should I stop taking?
  • What over-the-counter products should I stop using?
  • Do I need to see a dermatologist?
  • Are there any other specialists I should see?
  • What treatment would be best?

A note from Cleveland Clinic

There are many types of dermatitis. Some have an obvious cause while others, like perioral dermatitis, are unclear. It can be frustrating to have a rash and not know for sure where it comes from. Although topical steroids is thought to be the most likely cause, there are a variety of other theories. Work with your healthcare provider to narrow down what the cause might be. This will help you and your healthcare provider determine a treatment plan.

Perioral dermatitis is common, and there are effective treatments. Don’t hesitate to ask questions, follow your healthcare provider’s instructions and remember that your rash might get worse before it gets better.

Last reviewed by a Cleveland Clinic medical professional on 10/01/2020.

References

  • American Osteopathic College of Dermatology. . Accessed 9/8/2020. Perioral Dermatitis (https://www.aocd.org/page/PerioralDermatitis#:~:text=Perioral%20dermatitis%20is%20a%20facial,rare%20in%20men%20and%20children.)
  • American Academy of Dermatology Association. Accessed 9/8/2020. . Red Rash Around Your Mouth Could Be Perioral Dermatitis (https://www.aad.org/public/diseases/a-z/perioral-dermatitis)
  • NCBI. Hall MR, Tolaymat, L, Perioral Dermatitis, Treasure Island (FL): StatPearls Publishing; 2020. Accessed 9/8/2020.
  • American Osteopathic College of Dermatology. . Accessed 9/8/2020. Perioral Dermatitis (https://www.aocd.org/page/PerioralDermatitis)
  • Merck Manual. . Accessed 9/8/2020. Perioral Dermatitis (https://www.merckmanuals.com/en-pr/home/skin-disorders/acne-and-related-disorders/perioral-dermatitis)
  • American Academy of Dermatology Association. . Accessed 9/8/2020. Rosacea Resource Center (https://www.aad.org/public/diseases/rosacea)
  • CDC. . Accessed 9/8/2020.Candidiasis (https://www.cdc.gov/fungal/diseases/candidiasis/index.html)

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