Perioral Dermatitis

This common rash typically occurs around the mouth & nose. Periocular dermatitis is a variant that occurs around the eyes. It is classified as an inflammatory disorder of the skin. 

In 96% of cases the diagnosis is clinical, meaning no tests are required. 

In unusual cases they may order special tests to tell the difference from granulomatous rosacea, tinea incognito, granuloma faciale, lupus miliaris & atypical rashes. 

It may, but this can take months to years. Treatment courses of 4-6 weeks duration can clear up most cases. 

Your dermatologist will base treatments on your signs & symptoms. Most cases will settle within a few days. Cool compresses can help. In severe cases your dermatologist may give you a very short course of topical anti-inflammatories.

A non-irritating bland cleanser is best. La Roche, Cerave & Cetaphil are good cleansers. Above all avoid BHA/AHA cleanser & toners during the treatment phase.

Preferably a light one. Your dermatologist will advise you accordingly. Brands include Cetaphil, La Roche Posay, Obaji, & Aspect Dr. 

Ideally yes, but only for a week or two. This can accelerate the results of treatment. Be guided by your dermatologist. Oil based makeup is not advisable, mineral makeup is better if you are prone to getting perioral dermatitis.

1-2 weeks. If you are on a steroid preparation, it may flare up for a week before improving. Follow your dermatologist advice, & you will be fine. It’s important to take the course of medication to ensure it doesn’t come back. 

No, but it will leave some redness behind. This can take 4-6 months before disappearing. One to three simple vascular laser treatments can repair the skin & reduce redness. 

If you have been prescribed topical corticosteroids, you may have a transient flare up upon cessation. Don’t stress, continue to your prescribed treatment plan. Flare ups typically take 5-12 days to settle down. 

Yes. Most dermatologists will ask you to temporarily stop sunscreen for a short period, ranging from a few days to a week or two. You’re not going to age exponentially by doing so. 

POD is classic, especially if there is a history of steroid use, however other rashes may resemble perioral dermatitis, including- 

• Acne rosacea; usually has blackheads & or symptoms of rosacea
• Seborrheic dermatitis; usually has scalp or brow involvement
• Allergic or irritant dermatitis; may require allergy testing

Perioral dermatitis is frequently seen in children, the most common causes include corticosteroid use, including creams & inhalers. Treatment is per adult cases apart from the antibiotic we use. 

Most cases don’t, providing flare factors have been identified & avoided. 10-20% of patients have recurrent POD, possibly due to the wrong makeup, cleanser, moisturizers & skin care. 

Our team will advise you on the best solutions for your skin type.

Your dermatologist will figure that out. They may-

• Extend your course of anti-inflammatory medications
• Change your skin care & products
• Change medications & add lasers
• Think of other rare diseases that look like perioral dermatitis
• Consider patch testing
• Ask you to change your toothpaste

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

Though the exact cause is unknown, candida yeast & follicular infection with fusiform bacteria have been implicated.  The prescription given to you by your dermatologist does not target infectious processes but reduces skin inflammation.

Food is not a causative factor for perioral dermatitis. However, in some cases hot spicy food can irritate skin, worsening the rash. Acidic fruit juices are frequent irritants.

Allergies to food, metals & fluoridated toothpaste may present as perioral dermatitis like eruptions. In suspected cases your dermatologist may arrange allergy tests. 

Lasers are not the primary treatment choice; they can however reduce background redness & help repair the skin due to inflammation. 

Vascular lasers are the most used devices. Treatment takes a few minutes to perform, makeup can be worn the next day. Our nurses perform this procedure.

There are no scientific studies based upon natural remedies, however if you would like to give it a go you can try-

Azelaic acid twice a day for 6 weeks. It works in 20-30% of cases. This is technically organic as it is found in wheat, fungi & plants. Don’t try tea tree oil. 

Safely. The best way is with azelaic acid or topical erythromycin & pulse dye laser. You can negotiate oral therapy with your obstetrician (erythromycin). 

Stop the following: 

• Topicals
• Face creams, including moisturizers, toners, scrubs, masks
• Cosmetics including makeup
• Sunscreen
• Fluorinated toothpaste 

Commence on treatments as prescribed by your dermatologist, including 

• Simple cleansers
• Superlight moisturisers
• Medication for 3-6 weeks as directed
• In most cases you can apply light makeup & sunscreen at day 14-21

It’s complex. In most cases there are at least 2-3 factors in play.

Steroids & medications

• Steroid creams, lotions
• Inhaled spays

Cosmetics: 

• Moisturizers & heavy creams.
• Fluorinated toothpaste. 
• Oil based makeup
• Too much makeup

Other: 

• Hormonal changes 
• Skin barrier problems
• Problems with the immune system. 
• Candida albicans, demodex, bacteria

The most common cause is prescription steroids for a primary non-specific rash like seb dermatitis or irritant contact dermatitis (not allergic). From there, patients develop a steroid dependence. POD ensures & the rest is history.