Perioral Dermatitis Treatments: Heal the Rash Around Your Mouth & Nose

Perioral Dermatitis is a frustrating red facial rash around the mouth, nose or eyes, and often spreads to involve the chin or cheeks. Because the rash is not limited to the skin around your mouth, it is more accurately called periorificial dermatitis of the mouth, nose, eyes, or all of the above! It is all too common and has a tendency to flare up and come back after it has healed.

You can get rid of perioral dermatitis with the right approach that combines removing triggers, following an effective skincare routine, and seeking your dermatologist’s guidance when the rash is persistent.

In this guide I’m going to explain treatment options, prevention, symptoms, diagnosis, causes, and triggers - so you can heal and enjoy beautiful, radiant skin.

As a dermatologist, I recommend the following steps to take control:

1. Remove all irritants in skin care products or other exposures to skin areas where you have had periorificial dermatitis (more below)
2. Follow a gentle skin care routine to help your skin heal and resist new flare ups (see below)
3. See a dermatologist if the rash persists
4. Avoid triggers to prevent recurrence (more below)

Let’s dive in and learn about all of this:

What is Perioral Dermatitis?

Perioral dermatitis is a red rash on the facial skin and is one of the common rashes around the mouth. However, you can also have perioral dermatitis around the nose [1] (sometimes called perinasal perioral dermatitis), and eye perioral dermatitis (called "periocular perioral dermatitis"). Regardless of which facial “orifice” the dermatitis starts with, the characteristics of the rash and experience you have with it will be similar.

Why is Treatment Crucial?

Ignoring perioral dermatitis can lead to serious consequences. If not diagnosed and treated early, the red bumps can go very deep in the skin in what we call “granulomatous periorificial dermatitis”. The rash of untreated perioral dermatitis has a high risk for leaving scars and unsightly, lasting red or brown marks on your skin.

See the Treatment Options section below on how to manage and get rid of perioral dermatitis.

Symptoms and Diagnosis

This itchy and stingy rash around the mouth, nose, or eyes is not that uncommon, but it is very confusing. Most people with perioral dermatitis [2] come into my dermatology practice having no idea what has gone wrong with their skin.

What Does Perioral Dermatitis Look Like?

Perioral dermatitis looks like a combination of perioral eczema and acne pustules or even small acne-like blisters.

It usually manifests as bright red itchy pimples that may sting and little red blisters around the sides of the mouth. The bumps are often accompanied by scale that looks like perioral eczema or perinasal dermatitis.

Some sources say there is no itching, but that is not my experience or the experience of the many patients that I have treated with this skin problem. We have experienced itching with this inflammatory skin problem – yes, I have had it several times.

• The rash may start subtly at first with skin redness and bumps usually grouped together around the mouth, nose and/or eyes and gradually increase to involve more skin.
• It often starts at the angles of the lips, opening of the nose, or corners of the eyes.
• The rash typically extends onto the chin, up the crease to the nose and can move to the skin around the eyes.

The skin can get really red, inflamed and blotchy-looking. The pustules (bumps filled with white fluid) and blisters ultimately become very red, large and "juicy" looking. There may be scale causing the rash to appear as eczema around the mouth or nose.

Who Can Get It?

Anyone can develop perioral dermatitis but young adult women seem especially prone to it.

• Under 1% of people in the U.S. develop perioral dermatitis.
• 90% of the people who get perioral dermatitis are women.
• Most people who have perioral dermatitis are 20-45 years old.

Diagnosing Perioral Dermatitis

Most of the time, the diagnosis of perioral dermatitis is made based on clinical grounds, meaning how the skin looks and where on the face the rash is present.

Red bumps with pustules, small blisters and scale grouped along the sides of the mouth, nose or eyes is typical. Flaking scale may be present. The skin may be very red and the rash may extend to adjacent skin on the cheeks, the groove between the lips and nose and beyond. Sometimes the bumps are really deep and red, which we call granulomatous perioral dermatitis.

When in doubt, it’s best to see an experienced dermatologist for an accurate diagnosis.

How Do You Know if You Have Perioral Dermatitis or Something Else?

Perioral dermatitis is not the only rash that can surround the skin around your mouth, nose or eyes. This dermatitis can be mistaken for acne, rosacea and facial dandruff (aka seborrheic dermatitis). You need to know what the other common causes of a red rash are.

Rosacea

Rosacea is a common facial rash seen in adults. It usually causes redness, pimples, red bumps and scale on the ‘apples’ of the cheeks, nose, forehead and chin. This means the central curvey part of the skin in these areas. It typically spares the eye area and facial creases like between the nose and lips. Rosacea commonly causes ‘broken’ bloodvessles (large capillaries) in the nose creases and on the cheeks and chin.

People with rosacea often blush and flush easily turning beet red when exposed to harsh climates, exercise, emotional situations, etc. They may also develop sebaceous hyperplasia papules which are visible oil glands the size of a pencil tip or larger.

More About Rosacea:

• Acne Rosacea: Dermatologist’s Natural Treatment for Healing Rosacea
• Prescription Medication and Cosmetic Procedures to Treat Rosacea

Acne

Acne is another common rash that we are all familiar with. It is more common in teens and young adults.

Acne pimples are accompanied by the presence of blackheads. Pimples are typically filled with pus and can range from small to large cystic lesions. Acne typically involves the entire facial skin and may extend to the back, chest and neck.

Unlike acne, perioral dermatitis rash is typically limited to skin around the mouth, nose, and eyes. It may extend from there to other parts of the face but redness, bumps and scale will be present adjacent to the mouth, nose, and eyes.

More About Acne:

• How to Use Retin-A Tretinoin for Anti-Aging, Acne and Wrinkles
• The Best Toner for Acne Prone Skin

Seborrheic Dermatitis

Seborrheic dermatitis can occur in the nasolabial folds that run from the creases of your nose to the sides of your lips. Seborrheic dermatitis is a very common cause of perinasal dermatitis and is often seen as greasy scale and redness in the nose creases. In my experience, many people with perioral dermatitis also have seborrheic dermatitis (as evidenced by scale or redness along the creases of the nose). Seborrhea causes redness and scale. Only occasionally will pimples be present and may suggest Pityrosporum folliculitis. Unlike perioral dermatitis, there are no small blisters and the rash typically does not burn or sting.

More About Seborrheic Dermatitis:

• Facial Seborrheic Dermatitis Control Tips for Dry Flaky Skin on the Face and Around the Nose
• Seborrheic Dermatitis (Facial Dandruff) Causes and Treatments

Allergic Contact Dermatitis

You can also have an allergic contact dermatitis around your lips that will look like a rash encircling your mouth. It can happen around your eyelids too. The perioral eczema of an allergic contact dermatitis will involve the lips and very edge of the lip margin, called the vermillion.

Perioral dermatitis causes a rash around the lips and vermillion but does not involve them. [7]

Explore Further:

• Allergic Reaction Around the Eyelid and How to Treat Eyelid Dermatitis

Impetigo

Impetigo can look similar to perioral dermatitis. Both conditions make the skin red and are accompanied by bumps that sting and burn and that can weep fluid that dries as scale and crust.

Any part of your face can develop impetigo, including the skin around your eyes, nose and mouth. Plus, the skin around your nose is particularly prone to impetigo [3] because the germ, Staph aureus, can reside in your nose.

If you think that you have impetigo, you need to see your doctor for an accurate diagnosis and prescription antibiotic treatment.

Treatment Options

The treatment of perioral dermatitis is as surprising as the rash. Doctors don’t know the exact cause of this vexing skin problem, but there are effective ways to get rid of the rash.

Most patients who come to see me about this frustrating skin problem have seen other physicians, tried numerous topical creams and medicines and the rash gets worse and worse. Some of these treatments can actually worsen the rash.

It’s important to diagnose and get the right treatment or this dermatitis can leave scarring and post inflammatory pigmentation or erythema (brown or red marks that can last a long time).

There are very efficient self-care steps that can help get rid of perioral dermatitis, but if there are no improvements, finding a treatment requires a trip to the dermatologist.

How Long Does it Take to Get Rid of Perioral Dermatitis?

Perioral dermatitis is very slow to resolve with treatment. It may take at least 2 to 3 months to see sustained improvement such that you know that you are truly getting better. There will be daily ups and downs but what you are looking for to know that you are getting better is:

• The skin redness and bumps are slowly improving.
• There are fewer new lesions forming.
• The itching and burning is slowly easing and these symptoms are less easily triggered.

Gentle skin care (see the steps below) helps reduce recurrence and speed healing but this is still a rash that is very slow to improve and highly prone to relapse - making gentle skin care and avoidance of irritating products and other triggers a key part of your perioral dermatitis treatment.

In my experience, patients who are prone to perioral dermatitis typically go through a "spell" where they get it several times over a 2-to-5-year period. This happened to me. Being a dermatologist does not protect you from this vexing skin condition.

Patience and persistence with treatment and your gentle supporting skin care routine is important. If medicines are stopped too soon, or irritating skin care products are started before you are truly in remission, the rash comes right back.

Over the Counter Self-Care Treatment

1. Remove Irritants

The first treatment step is to prevent all irritating skin care products and medicines from touching the areas of your skin suffering from perioral dermatitis.

The areas of skin with active dermatitis have a broken skin barrier and are easily irritated – much like putting lemon juice on a cut.

This means not applying:

• glycolic acid
• other AHA acids
• retinoids
• alcohol containing skin toners or other products
• harsh skin cleansers
• some acne medicines such as benzoyl peroxide or salicylic acid
• any product that stings when applied to the rash (including products you have used successfully before such as chemical sunscreens, makeup, etc.)

Remember: Skin care products will migrate on your skin as they warm which means you need to keep the products listed above well away from the areas of skin that have perioral dermatitis.

2. Avoid Triggers

Stop using products potentially linked to causing perioral dermatitis:

• fluoride containing toothpaste and dental care products
• strong prescription (halogenated) cortisone creams
• steroid inhalers (your prescribing physician needs to supervise this and may need to prescribe an alternative medicine)

See more about common causes and triggers below.

3. Follow a Non-Irritating Skincare Routine

The key step is to create a healing, non-irritating skincare routine with the right products that gently cleanse, soothe, and moisturize to allow the skin to heal.

Start your treatment with the skin care regime below to restore your skin barrier and achieve a smooth, clear complexion:

4-Step Skincare Routine and Products to Treat Perioral Dermatitis

Below is the 4-step routine and the products I’ve been very successfully using in my dermatology practice for my patients suffering from perioral dermatitis.

Choose the Right Skincare Products

Get all the non irritating products you need for your gentle skin care routine to help get rid of perioral dermatitis in my Complete Skin Care Kit.

This healing skin care Kit is always part of how I start to treat my patients. I give my patients very specific instructions on how to care for their skin and how to add in additional prescription and nonprescription medicated products into this routine.

Follow my proven steps below, using these products to help support healthy skin for even the most sensitive skin and stubborn skin problems:

1. Cleanse: Wash Facial Skin with a Non-Irritating Cleanser

Twice daily:

• Wash your face with the pH balanced and hypoallergenic Extremely Gentle Foaming Facial Cleanser (included in the Kit). An alternative cleanser is VaniCream Soap.
• Rinse the cleanser off entirely with warm-to-tepid water and gently pat the skin dry. Retained cleanser residue - no matter how gentle - can irritate skin.

I have my patients use this gentle cleansing routine until the skin is no longer red and angry, which may take about a month.

• At this point, we introduce pyrithione zinc into the cleansing routine by adding my naturally made Calming Zinc Soap once a day alternating with the Extremely Gentle Cleanser.

• We wait because Calming Zinc can be drying. But, it is also helpful because it contains a full 2% pyrithione zinc to help target and control skin yeast germs that may play a role in this rash.
• I have my perioral dermatitis patients use Calming Zinc indefinitely because I find that it helps to prevent recurrences.

2. Correct: Soothe Inflammation and Apply Medicines

• Apply my Green Tea Antioxidant Skin Therapy in the morning and at night. (included in the Kit)
• Layer any prescription or non-prescription medicines. In my practice, I typically use a topical prescription antibiotic medicine and an antifungal cream such as non-prescription clotrimazole on top of the Green Tea. See the section below about medicines dermatologists use.
• I like my patients to continue using the Green Tea as part of their preventative skin care even when the perioral dermatitis has healed. Learn about prevention and flare-ups below.

Pro tip: The green tea EGCG polyphenol antioxidants help soothe inflammation, reduce redness, and reload skin antioxidants depleted by the inflammatory rash. Read more about the skincare benefits of green tea.

Important: until your perioral dermatitis is healed (often 3 months after you start a successful treatment) the rest of the face must be cared for gently with products like you find in my Complete Skin Care Routine. This is because all face care products will warm on your skin and migrate into the areas with perioral dermatitis. Thus, if you apply harsh acne or anti-aging products to adjacent skin, it will eventually migrate onto the areas of skin suffering from perioral dermatitis and irritate it. It’s why we start with a gentle skin care routine!

3. Hydrate: Heal the Skin Barrier

• Apply my Daily Moisturizing Face Cream as an all-over facial moisturizer.

This deeply hydrating and non-irritating moisturizer is the best moisturizer for skin struggling with perioral dermatitis.

4. Protect: Block UV Exposure and Cover the Redness

• Apply my Pure Physical Matte Tinted Sunscreen

This zinc oxide sunscreen will protect your inflamed skin from UV exposure, which can cause permanent uneven skin pigment problems. Even sun coming through window glass can pigment inflamed skin. There are no irritating chemicals in this pure mineral SPF and the subtle tinting with iron oxide will help to hide the redness while your skin heals. Avoid chemical sunscreens that can irritate perioral dermatitis.

• For additional camouflage, apply pure mineral makeup powder to avoid makeup ingredients that may sting.

The Routine that Works

The skin care routine in my Complete Skin Care Kit plus the Calming Zinc Soap has helped many of my patients and customers get rid of perioral dermatitis. Here is one of the testimonials I received:

I suffered for so many months and your products are the only thing that saved me! I had really bad perioral dermatitis around my nose with major redness swelling and pustule bumps that would just not go away. I had literally tried everything over the counter as well as Elidel prescription from a dermatologist. The Elidel would work for a few days and it would get bad again. Luckily, I googled products for perioral dermatitis and your website came up.I wound up getting the Extremely Gentle Cleanser, Calming Zinc soap, Green Tea Antioxidant Skin Therapy, Daily Moisturizer, and Sheer Strength Sunscreen. All have been amazing. The routine doesn’t clog pores and it’s non greasy. I have also bought some of the loose powder face makeup. I think the drugstore sunscreens with oxybenzone I’m allergic to. Your products are amazing and I can’t say enough good things about them. - A.M.