What is Perioral Dermatitis?

Perioral dermatitis (sometimes called periorificial dermatitis) is an inflammatory skin rash that develops around the mouth. It typically appears as clusters of small red or pink bumps (papules) on a background of red, irritated skin. In lighter skin tones, the bumps often look red and acne-like, while in darker skin they may be flesh-colored or slightly darker. Despite its pimple-like appearance, this rash is not acne but a form of dermatitis (skin inflammation). The affected skin can feel itchy or burning, and is usually dry and flaky. A classic sign is that the area right next to the lip line is often spared – in other words, there may be a narrow band of normal-appearing skin around the border of the lips, with the rash just beyond that area. Perioral dermatitis most commonly occurs around the mouth (hence “peri-oral,” meaning “around the mouth”), but it can also spread to the lower sides of the nose or even around the eyes in some cases. It is important to know that perioral dermatitis is not contagious, so it cannot be passed to other people.

Who Gets This Rash?

Perioral dermatitis can affect anyone, but it is seen most often in adult women between about 20 and 45 years old. Women in this age group who use facial creams or topical steroids on the face are at particularly high risk. That said, men and children can also develop perioral dermatitis. In children, it may sometimes have a slightly different appearance (such as more skin-colored or yellowish bumps in a variant called granulomatous periorificial dermatitis), but it is essentially the same type of rash. 

What Causes Perioral Dermatitis?

The exact cause of perioral dermatitis isn’t fully understood. Dermatologists consider it a multifactorial condition, meaning several triggers or contributing factors may lead to the rash. Often, something is irritating the skin around the mouth and causing inflammation. Here are some common triggers and risk factors that have been linked to perioral dermatitis:

• Topical Steroid Creams or Sprays: The use of steroid creams on the face is a well-known trigger for perioral dermatitis. People often apply hydrocortisone or other corticosteroid creams to the face for other rash conditions, and over time this can lead to perioral dermatitis. Even prescription steroid nasal sprays (used for allergies) or inhalers (for asthma) have been associated with causing this rash around the mouth/nose. In fact, topical steroids are considered one of the most likely causes in many cases of perioral dermatitis.
  
  
• Heavy Face Creams, Ointments, and Cosmetics: Using thick, heavy moisturizers or cosmetic products on the face can trigger the rash. Many patients with perioral dermatitis have been using facial creams, night creams, or oily makeup products before the rash appears. These products may create a heavy occlusive layer on the skin that traps sweat and irritants, disrupts the skin barrier, or causes follicular plugging – leading to inflammation. Wearing heavy foundation makeup is another potential trigger; the rash is sometimes seen in people who regularly use cosmetic cover-ups around the mouth and chin.
  
  
• Fluoridated Toothpaste and Dental Products: Some studies and reports suggest that fluoride in toothpastes or certain tartar control ingredients can contribute to perioral dermatitis in susceptible individuals. The evidence is not conclusive, but as a precaution I often recommend switching to a mild, non-fluoride toothpaste if you have this condition. Eg Grant’s toothpaste (https://www.grantsofaustralia.com.au/collections/fluoride-free-toothpaste) Similarly, heavy use of mouthwash or dental irritants might aggravate the skin around the mouth in some people. Chewing gum has even been reported as a trigger in a few cases (possibly due to minor skin irritation from frequent chewing or certain gum ingredients).
  
  
• Physical Irritants and Environmental Factors: Anything that chronically irritates the perioral area can play a role. Repeated friction or occlusion around the mouth is one example. Notably, we have observed that face masks (such as those worn for COVID-19 protection) can precipitate or worsen perioral dermatitis in many patients. The mask traps heat and humidity and causes friction on the skin – a combination that can trigger acne-like rashes and perioral dermatitis (sometimes dubbed “maskne”). Strong winds and excessive sunlight (UV light) have also been cited as possible aggravating factors – wind can dry and chap the skin, and UV exposure might inflame sensitive skin. Hormonal changes (for example, fluctuations related to menstrual cycle or birth control pills) have been reported to coincide with flare-ups as well. High stress levels might be another contributor, as stress can affect hormones and immune response (some patients notice flares during times of stress).
  
  
• Impaired Skin Barrier or Microbial Factors: Healthy skin has a natural protective barrier and a balance of microorganisms (the skin flora). In perioral dermatitis, there is a theory that an alteration in the skin’s normal bacteria or yeast may contribute. For instance, Candida (yeast) overgrowth or certain bacteria (like fusiform bacteria) have been found in some cases. Likewise, an overpopulation of Demodex mites (microscopic mites that live in facial hair follicles) has been suggested as a possible factor, similar to their role in rosacea. These findings suggest that when the skin’s barrier is disrupted (by harsh products or steroids) and normal flora gets out of balance, inflammation can result. Keeping the skin barrier healthy is therefore an important part of management (more on that later).
  
  

It’s important to remember that each person’s case may be different – one patient’s flare might be clearly linked to their steroid cream use, while another’s might be worsened by their cosmetics or even by environmental conditions. Often, multiple factors together set the stage for perioral dermatitis. In many cases, the initial step in treatment is to eliminate the suspected triggers, which can lead to improvement on its own.

How Is Perioral Dermatitis Treated?

Treating perioral dermatitis typically involves a combination of eliminating offending products, following a gentle skincare routine, and using medications or therapies to calm the skin. It’s important to approach treatment with patience – this rash may take weeks or even a few months to fully clear in some cases. The plan will usually include:

1. Stop the Triggers (Zero Therapy)

The first and most crucial step is often described as “zero therapy,” which means discontinuing anything that might be causing the rash. If you have perioral dermatitis, you will be advised to stop using the following immediately:

• Topical steroids: Do not apply any steroid creams or ointments to your face (and if you were prescribed a steroid for another reason, ask your doctor for an alternative). Stopping steroids can initially cause a rebound flare – the rash might get a bit worse before it gets better, but this is expected. It’s important not to resume the steroid, as that will only give temporary relief and worsen the cycle.
  
  
• Heavy face creams and moisturizers: Pause the use of moisturizers, oily creams, and ointments on the face. While it feels counterintuitive to not moisturize dry skin, these products may be perpetuating the rash. In the short term, allowing the skin to “dry out” a bit can help the dermatitis resolve faster. You can later reintroduce an appropriate light moisturizer once the rash improves – see Skincare Tips below.
  
  
• Cosmetics and makeup: Avoid makeup on the affected area, especially liquid or cream foundations and heavy concealers. These can occlude the skin and worsen the rash. If you must use some makeup for work, choose oil-free, non-comedogenic products and use them sparingly, but ideally take a break from cosmetics until the rash clears.
  
  
• Sunscreen (temporarily): Sunscreens, particularly chemical sunscreen creams, can irritate perioral dermatitis. It’s often recommended to stop using facial sunscreen during an active flare. Instead, protect your skin by wearing a wide-brim hat or seeking shade. Once the rash improves, you can patch-test and use a gentle mineral (physical) sunscreen formulated for sensitive skin.
  
  
• Fluoridated toothpaste: Switch to a non-fluoride toothpaste. Also avoid tartar-control or highly flavored toothpastes for now, as well as strong mouthwashes, to minimize potential irritants contacting the perioral skin.
  
  
• Chewing gum: Avoid chewing gum or other oral irritants (like cinnamon or minty candies) that have prolonged contact or effect around the mouth. Even subtle mechanical or chemical irritation from these can be a factor for some patients.
  
  

By eliminating these triggers, we remove the fuel feeding the rash. Many patients will see improvement just by doing this, although it can take time and the initial worsening (especially after stopping steroids) can be discouraging. Stick with it – after the rebound flare settles, usually the rash will begin to improve within a few weeks.

2. Medications and Topical Treatments

In addition to stopping any offending products, Dr. Chris Irwin often prescribes medications to help calm perioral dermatitis. These can be applied to the skin (topical treatments) or taken by mouth (oral treatments), depending on the severity. The goal of these medications is to reduce inflammation, fight any bacterial components, and help restore the skin’s normal condition. Common treatments include:

Topical medications: These are creams, gels, or lotions you apply to the affected skin, usually once or twice daily. Some options your doctor might use are:

• Calcineurin inhibitors: These are non-steroid anti-inflammatory creams like pimecrolimus (Elidel®) or tacrolimus. This is generally my first choice to help. They work by quieting the skin’s immune response and can help clear the rash without the side effects of steroids. We often prescribe these especially if a patient needs to come off steroid cream – pimecrolimus can ease the transition and control the dermatitis.
  
  
• Azelaic acid: a gel or cream that has anti-inflammatory and anti-bacterial properties. Another one of my favourite treatments. It’s commonly used in rosacea and can help perioral dermatitis by calming redness and bumpiness. It may cause mild stinging initially but is generally well tolerated on sensitive skin.
  
  
• Topical antibiotics: such as metronidazole cream/gel, clindamycin lotion, or erythromycin gel. These help reduce inflammation and bacterial load, and are often very effective. Metronidazole in particular is a well-known therapy for perioral dermatitis and rosacea to reduce redness and bumps.
  
  
• Sulfur preparations: Sulfur-based creams or washes (sometimes combined with sulfacetamide) have been used for decades in treating perioral dermatitis. Sulfur helps by fighting bacteria/yeast and reducing inflammation. There are over-the-counter sulfur washes and masks that some patients use at home (e.g. products for acne/rosacea containing 5-10% sulfur) – these can be helpful if used gently (maybe a few times a week).
  
  
• Retinoids (Vitamin A creams): A mild retinoid like gel is sometimes used, particularly if there is a co-existing acne-like component. Retinoids help unclog pores and promote skin turnover. However, in perioral dermatitis they must be used carefully since they can be irritating – often at a low concentration and applied infrequently.
  
  
• Photodynamic therapy (PDT): In certain cases, dermatologists may perform PDT, which involves applying a special light-activated solution (5-aminolevulinic acid) to the skin and then using an LED (we use Medilux). This treatment can reduce the rash by targeting sebaceous (oil) glands and inflammation. PDT is more commonly used for acne or sun-damage, but it has been reported to help perioral dermatitis when other treatments fail.
  
  

Oral medications: For more severe cases or when topical treatments aren’t enough, oral medications can be very effective. These work systemically to reduce skin inflammation. Your doctor may prescribe:

• Oral antibiotics (tetracycline class): Low-dose oral antibiotics are a mainstay for moderate to severe perioral dermatitis. Tetracycline, doxycycline, or minocycline taken by mouth for a few months can significantly calm the rash. These antibiotics are valued not just for fighting bacteria, but for their anti-inflammatory properties, which help reduce the redness and bumps. Typically, I might recommend a 4-12 week course. In general we try to avoid long term oral doxycycline use.
  
  
• Oral antibiotics (erythromycin): If tetracycline-type antibiotics are not suitable (for example, if you are pregnant or a young child), an alternative is erythromycin by mouth. Erythromycin is considered safe in pregnancy and for children, and can also help clear perioral dermatitis, though higher doses may be needed than with tetracyclines.
  
  
• Isotretinoin: In rare, very resistant cases, a dermatologist might consider a low dose of isotretinoin. Isotretinoin is a powerful vitamin A derivative that drastically reduces oil gland activity and inflammation. This is generally a last-resort option when other treatments fail, given its side effect profile. It can be very effective in chronic perioral dermatitis but requires careful monitoring.
  

3. Advanced Therapies: Light & Laser Treatments

Light based therapies in combination with the above medications will drastically increase the clearance of perioral dermatitis. Here we focus on two cutting-edge technologies available with us at The Skin Doctor: LED phototherapy (MediLUX LED system) and laser therapy (with the Fotona Dynamis SP Pro laser).

LED Phototherapy (Light-Emitting Diode Therapy)

LED phototherapy is a gentle, non-invasive treatment that uses specific wavelengths of light to stimulate healing in the skin. The MediLUX LED is a top of the line medical-grade device that delivers light in different colours (wavelengths) to target various skin concerns. LED therapy is painless – you simply sit or lie down under an array of lights for a set time, and the light energy penetrates into the skin to exert beneficial effects at the cellular level.

Different colours of light have different benefits: for instance, blue light (around 415 nm) is often used to kill acne-causing bacteria and reduce oil, red light (633 nm) penetrates deeper to boost circulation and collagen for skin rejuvenation, and near-infrared (830 nm) light promotes cellular repair and wound healing. For inflammatory conditions like perioral dermatitis, the most helpful tend to be the anti-inflammatory wavelengths such as green (520 nm) and yellow (590 nm) light, as well as red and infrared. Green light has a calming effect on the skin – it helps reduce redness and irritation, leading to a more balanced, calm complexion. Yellow light penetrates a bit deeper; it can stimulate skin healing and collagen production while reducing redness, and has been found beneficial for conditions like perioral dermatitis and for soothing the skin after laser treatments. Near-infrared light works even deeper to support tissue repair and reduce inflammation in the skin.

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Ideally, LED sessions would be done once or twice a week for 4-8 weeks. Due to the gentle photobiomodulation effects of LED, it can take time to see results. But with consistency it can help to greatly improve the integrity of your skin, improve your skin barrier functioning and reduce inflammation and irritation.

Overall, LED phototherapy is a useful supportive treatment for perioral dermatitis. It is non-invasive (no needles, no surgery), requires no downtime, and can be used in all skin colors safely. 

Laser Treatment (Fotona Dynamis SP Pro)

Once your perioral dermatitis has calmed and active inflammation has settled, Fotona’s FRAC3 laser treatment can be a gentle and effective option to help improve your skin’s appearance and support long-term skin health.

FRAC3 is a non-invasive Nd:YAG laser treatment that uses short bursts of energy to target deeper layers of the skin without damaging the surface. The non-ablative fractional laser delivers energy in a 3-dimensional pattern, focusing on gently breaking down skin imperfections, whilst stimulating collagen production and encouraging your skin to naturally repair itself from within.

How it can help post-perioral dermatitis:

• Reduces lingering redness and uneven skin tone left behind after a flare
  
  
• Improves texture and scarring that may have developed from previous inflammation
  
  
• Strengthens the skin barrier, making it more resilient over time
  
  
• Supports healing by boosting circulation and cell turnover
  
  

FRAC3 utilises lower energy and short pulse durations, making it a very gentle, toning treatment. Whilst it’s still important that the active inflammation of the dermatitis has subsided, it is a fantastic treatment for people who suffer with reactive-type skin due to the minimal downtime and the treatments ability to improve skin structure and integrity – making your skin more resilient over time.

What to expect:

• Treatments are quick, with minimal discomfort
  
  
• There is no significant downtime, although mild warmth or redness may occur for a few hours after treatment
  
  
• A series of 3-6 sessions spaced 2 weeks apart recommended for best results

This treatment can be a valuable part of your post-dermatitis skin recovery plan. Your doctor and dermal clinician will assess your skin to ensure it’s ready for laser and customise the treatment to suit your skin’s needs.

Skin Care Tips and Cosmeceuticals

One of the most important aspects of managing perioral dermatitis (and preventing it from coming back) is how you care for your skin on a daily basis. Because this condition is often triggered or worsened by topical products, adopting a gentle skin care regimen is key. Below are some do’s and don’ts – essentially, which products or ingredients can help and which can hurt.

Skincare Do’s (Helpful Practices):

• Keep it simple and gentle: Use a very mild cleanser or just plain lukewarm water to wash the affected area. When your rash is active, it might be best to avoid soap altogether or use a fragrance-free, irritant-free cleanser (for example, something made for sensitive skin or a sulfate-free cleansing lotion like Bioderma’s Sensibio Micellar Cleansing Oil and Sensibio Gel Moussant). Pat your skin dry gently; do not scrub with a washcloth or exfoliating brush.
  
  
• Hydrate the skin (with the right moisturizer): Even though we tell you to stop heavy creams during a flare, you don’t want the skin to crack or become excessively dry either. The trick is to use a light, plain moisturizer that doesn’t occlude the skin. Look for oil-free, non-comedogenic moisturizers that have ingredients like ceramides, glycerin, hyaluronic acid, or niacinamide (Vitamin B3) – these help repair the skin barrier and soothe irritation without being greasy. Apply just a thin layer to the rash area if it feels uncomfortably dry or tight. Niacinamide in particular is a great ingredient for perioral dermatitis because it can reduce inflammation and strengthen the skin barrier (many over-the-counter serums or moisturizers contain 4-5% niacinamide and are well tolerated by sensitive skin). We stock various moisturisers which are suitable for dermatitis prone skin; our dermal clinicians can help to recommend a product which would be suitable for you. Natural moisturizers like plain aloe vera gel or virgin coconut oil can also be considered for small areas – research suggests coconut oil can be a safe, effective emollient that may even help fight bacteria and support wound healing. If you do use a natural oil, apply sparingly to avoid pore blockage.
  
  
• Sun protection: Once the acute dermatitis is settling, sun protection becomes important again. Sun exposure can aggravate the redness and also increase the risk of post-inflammatory hyperpigmentation (dark marks) after the rash. Choose a mineral sunscreen (with zinc oxide or titanium dioxide) as these are often better tolerated by sensitive skin and help deflect UV rays without penetrating the skin. Look for formulas labeled for sensitive skin or baby sunscreen, which usually means no harsh chemical filters or fragrances. Remember, physical sun protection like wearing a hat is helpful too. During an active flare, if sunscreen stings your skin, it’s okay to rely on hats and shade until you’ve healed a bit.
  
  
• Use fragrance-free, hypoallergenic products: This applies to everything you put on your face – from your cleanser and moisturizer to makeup and sunscreen. Fragrances and unnecessary additives in skincare can irritate and prolong perioral dermatitis. Switch to products that are labeled “fragrance-free” and ideally have short ingredient lists. Also, patch test new products on a small area first once your skin has cleared, to make sure they don’t trigger a recurrence. Maintaining a gentle routine even after the rash is gone will help prevent future flares.
  
  

Skincare Don’ts (What to Avoid):

• Avoid heavy or occlusive creams: As noted earlier, do not go back to using thick, greasy moisturizers or steroid creams on your face. Even after your skin improves, stick with lighter lotions rather than heavy cold creams or ointments. Anything that blocks the skin too much can create the warm, moist environment that the dermatitis likes to return in. If you have areas of facial eczema that truly need a heavy ointment, discuss with your doctor – they might have you use something like tacrolimus ointment instead of a steroid, or find a balance that doesn’t set off perioral dermatitis again.
  
  
• No harsh “actives” or exfoliants during a flare: It’s very important to avoid irritating skincare ingredients while you’re dealing with perioral dermatitis. That means no scrubs, no facial exfoliating brushes, no alpha or beta hydroxy acid peels, no glycolic/salicylic acid toners, and no retinol or prescription retinoids (unless specifically recommended by your dermatologist in a controlled way). These can all inflame your skin further. One source recommends avoiding any exfoliants or harsh actives during flare-ups because they will only worsen the irritation. Similarly, benzoyl peroxide (a common acne treatment) can be too harsh for this condition and may make the redness and dryness worse – so skip any acne spot treatments unless your dermatologist okays it. In short, keep the skincare routine very bland and gentle until fully healed.
  
  
• Avoid heavy makeup, especially foundation: We mentioned this in triggers, but it bears repeating – heavy makeup can aggravate perioral dermatitis. Liquid foundations, cream contours, etc., often contain oils or silicones that form a film on the skin. During an active rash, try to avoid these entirely. If you must use some makeup to cover redness, opt for a light mineral powder foundation which is usually less irritating (and oil-free). Always remove all makeup completely at the end of the day with a gentle cleanser, because residue can also irritate the skin.
  
  
• Be cautious with “natural” or home remedies that can irritate: Not everything natural is safe for broken-out skin. For example, some people try apple cider vinegar or tea tree oil for skin issues – do not use these on perioral dermatitis, as they are too harsh and can cause burns or allergic reactions on sensitive skin. Similarly, cinnamon, menthol, peppermint, or any product that “tingles” is a no-go for now. Even fluoride toothpaste we covered – switch that out if possible. Basically, if it’s not plain and gentle, avoid it.
  
  
• Don’t pick or scrub the bumps: Perioral dermatitis might look like acne, but you should never pick, squeeze, or scrub the bumps. Picking can lead to infection or scarring, and scrubbing will make the irritation worse. Let the medications and treatments do their job. If you have flaking, it’s better to soften it with a damp cloth gently rather than forcibly peeling it. Hands off the face as much as possible!
  
  

By following these skincare guidelines, you’ll be supporting your skin’s recovery and preventing recurrence. Once the dermatitis clears, continue to avoid the original triggers – for example, if we suspect steroid cream was the cause, don’t use it again on your face. If heavy cosmetics were to blame, maybe find lighter alternatives or limit their use. Think of your skin as sensitive now, and treat it accordingly with TLC.