It starts as a few tiny red bumps beside the nose or at the corners of the mouth. They burn a little, the skin feels tight and flaky, and every cream you try seems to help for a day and then make it worse. A steroid cream from the chemist calms it quickly, until you stop. This pattern is typical of perioral dermatitis.
Doctors also call it periorificial dermatitis, because it can appear around the nose and eyes as well as the mouth. It’s common, harmless in the long run, and very treatable once the trigger is removed.
What it looks like
- Clusters of tiny red or skin-coloured bumps, sometimes small pus spots, on a red, slightly scaly background.
- Around the mouth and chin, the sides of the nose, and sometimes around the eyes.
- Often a narrow clear strip of skin right next to the lips.
- Burning, stinging or tightness more than pain; sometimes mild itch.
- Dry, flaky patches among the bumps.
- Most common in women aged about 20 to 45, but it also affects men and children.
Why it happens
The exact cause isn’t fully understood; a weakened skin barrier seems to be part of it. The most common trigger by far is steroids on or near the face:
- Steroid creams, including the “fairness” and “three-in-one” combination creams sold over the counter. Our post on steroid creams on the face explains why these are a common problem in India.
- Steroid inhalers and nasal sprays, especially when the spray lands on the skin.
Other things that can trigger or worsen it:
- Heavy, greasy creams and ointments, and many layered products;
- some cosmetics and, in some people, toothpaste or a thick sunscreen;
- hormonal changes, such as the pill or pregnancy;
- heat, sun and wind.
It isn’t contagious and isn’t caused by poor hygiene.
What to do
- Stop steroid creams on the face, unless a doctor has prescribed one and asked you to taper it. Expect a flare for a week or two after stopping: that’s the skin coming off the steroid, not a sign that you need it. If you’ve used a strong cream for a long time, ask a dermatologist to help you step down.
- Don’t stop prescribed inhalers or nasal sprays for asthma or allergies. Instead, rinse your mouth after inhalers and wipe the skin around the nose after sprays; tell your doctor about the rash.
- Strip your routine back. While the rash settles, wash with lukewarm water or a very gentle cleanser, and use only a light, fragrance-free moisturiser if the skin feels tight. Dermatologists sometimes call this “zero therapy”.
- Pause makeup, scrubs, toners and actives (retinoids, acids, vitamin C) on the area.
- Use a light gel or fluid sunscreen if you’re outdoors, rather than a thick cream.
- Don’t pick or squeeze the bumps, and don’t switch between new products every few days.
Many mild cases improve with these steps alone over several weeks. If not, treatment speeds things up.
What not to use
- Acne products such as benzoyl peroxide or strong exfoliants, which usually irritate it.
- Antifungal-steroid combination creams “just to try”.
- Home remedies such as lemon, toothpaste or turmeric pastes on the rash.
Is it perioral dermatitis or something else?
- Acne has blackheads and whiteheads and isn’t limited to the area around the mouth; see acne.
- Seborrhoeic dermatitis gives flaky patches beside the nose and in the eyebrows, often with dandruff; see seborrhoeic dermatitis on the face.
- Rosacea causes flushing and bumps across the cheeks and nose.
- Contact dermatitis around the lips may follow a new lipstick, lip balm or toothpaste and is usually itchier.
- Lip-licking dermatitis gives a dry, dark ring right up to the lip edge; see dark lips.
When to see a dermatologist
See a dermatologist if:
- the rash hasn’t improved after a few weeks of stopping products;
- it flares badly after stopping a steroid cream;
- it’s spreading to the cheeks, eyelids or forehead;
- it’s around a child’s mouth, nose or eyes;
- you’re pregnant and the rash appeared;
- you aren’t sure what the rash is.
How a dermatologist treats it
At the consultation, the doctor examines the rash, asks about every cream, inhaler and spray you use, and rules out look-alikes. Treatment may include:
- A plan to come off steroid creams safely, sometimes stepping down or switching to a non-steroid anti-inflammatory cream.
- Prescription creams or gels, such as metronidazole, erythromycin or azelaic acid, used for several weeks.
- A course of anti-inflammatory antibiotic tablets for more widespread rashes, usually over several weeks; different choices are used in pregnancy and in children.
- A simple routine to return to: which cleanser, moisturiser and sunscreen to use, and which products to keep away from the area.
Most people clear in about four to eight weeks. Perioral dermatitis is one of many everyday skin problems we see in skin specialist consultations in Rajkot.
The short version
Perioral dermatitis is a burning rash of tiny red bumps around the mouth, nose or eyes, often with a clear strip beside the lips. Steroid creams are the most common trigger, and heavy creams and cosmetics can add to it. Stop the steroid cream (expect a short flare), strip your skincare back to water and a light moisturiser, and don’t treat it like acne. If it doesn’t settle, a dermatologist’s treatment usually clears it within about two months.
