About peri-oral dermatitis

The primary symptom of perioral dermatitis is a red rash around your mouth. The rash may be scaly or dry and flaky and can be accompanied with inflamed bumps. Although it is usually found around the mouth, the eruption can also move to your eyelids and nose. Sometimes it itches, sometimes it burns, sometimes the skin feels tight or sore. It commonly affects women between 20 and 50 years old.

Classic peri-oral dermatitis is usually triggered by use of steroid creams on the face but it can also be triggered by steroid tablets or inhalers taken for another medical condition. 

From my experience I also see peri-oral dermatitis in patients with compromised skin barrier. This can be triggered by using the wrong skin care for your skin type or the right skin care in the wrong way or the wrong combination or switching too much from one product to another.

Sometimes other conditions are labelled peri-oral dermatitis because the eruption is affecting the area around the mouth. For example eczema and contact dermatitis can affect the peri-oral area.

Work up may include a full skin examination and sometimes patch testing to look for an underlying contact allergy (eg to lipsticks, toothpaste ingredients) but usually a clinical examination will be enough. Occasionally a skin biopsy will be considered if the diagnosis is not clear or patient will be referred for an analysis of the gut health. 

The standard approach to treatment of peri-oral dermatitis involves taking oral antibiotics but milder cases may settle with antiseptic or antibiotic creams. Steroid creams will have to be discontinued and sometimes topical calcineurin inhibitors will have to be added to help discontinuing the steroids. The skin care routine will have to be optimised, which often means minimising the products used and discontinuing all skin products potentially compromising the skin barrier. Products helping to restore the skin barrier might be recommended.