Perioral dermatitis is on the rise: how to know if you have it and how to treat it

If you've got rashy red bumps on your face, especially around your nose and mouth, you're not alone. So-called perioral dermatitis is on the rise and skin doctors such as consultant dermatologist and Klira Skin founder Emma Craythorne are flagging it. “In my practice, I am seeing more people with it than I used to,” she says. 

It had a brief flare-up during the pandemic as a side-effect of mask-wearing ('maskne') but now it seems to be back again, with one of the chief causes being too much of the wrong skincare. Yup, it's avoidable.  "We’re now seeing a lot of perioral dermatitis to do with the high number of products and therefore chemicals that people put on their skin,” says Craythorne. “This will affect the skin barrier and may cause a change in the skin microbiome,” she says.

Even derms themselves aren't immune. Dr. Lindsey Zubritsky posted on her @dermguru TikTok feed where she has 1.3m followers, that she gave herself PD from product overuse. "I thought my skin was invincible," she said.  She showed pictures of her perioral dermatitis and explained how she fixed what looked like a mild case within a week. 

However, it can be tough to shift, as influencer Alix Earle told her six-and-a-half million TikTok followers. She said she had had "red bumps" around her nose and mouth that had been "coming and going for the past few months." Dermatologist  Dr. Shereene Idriss spotted that Earle's rashy bumps were PD. "Often it can be asymptomatic, so you don't really feel them," she says, but they can cause burning and itching sensations too.

Long-suffering Hailey Bieber wrote back on Instagram back in 2020 that she'd had it "for a few years" on her cheeks, around her mouth and under her eyes. It was triggered, she said, by harsh products, the weather, certain SPFs and wearing face masks.  Unsurprisingly Hailey Bieber's skincare brand Rhode , which she went on to launch, is on the gentle side.

What exactly is perioral dermatitis anyway and how do you know if you have it or another condition such as eczema? More importantly, how can you get rid of it? Let's find the answers and the products you need.

What is perioral dermatitis?

Perioral dermatitis, or ‘skin inflammation around the mouth’ is just that – a rash of tiny flat-top bumps concentrated around your mouth. “It can also sit just underneath the nose, in the crevice down to the nasolabial folds, and looping around the chin area,” says Dr Craythorne, adding that it, uniquely, can also appear in the eye area. It can burn but it’s also possible you don’t feel it at all.

What does perioral dermatitis look like?

It can either manifest as small (sometimes pinhead-small) individual fluid or pus-filled flat bumps, but it can also look like a rash of bright-red (or purplish or brown if your skin is dark), inflamed skin that can appear almost burnt. Under the nose, it can look like you have a cold and you’ve rubbed you skin raw. Sometimes the skin goes scaly, but sometimes it doesn’t. Unhelpfully, “it can appear like a cross between acne, rosacea and eczema, all rolled into one,” says Craythorne.

What can be confused with perioral dermatitis?

The big issue with perioral dermatitis (PD for short) is that it can look so much like other skin diseases, it often gets misdiagnosed. The best thing is to see a dermatologist to diagnose you properly, as the correct treatment makes all the difference. But Craythorne has some helpful pointers nonetheless:

• Difference between perioral dermatitis and acne

Unlike PD, acne “typically comes with blackheads, whiteheads and/or inflamed pustular blemishes,” says Craythorne. Acne often located around the outer edges of the face, she points out, rather than being focused around the mouth. Acne doesn’t appear around eyes.

• Difference between perioral dermatitis and rosacea

Rosacea tends to “occur around the nose and cheeks rather than the mouth and in most cases comes without blackheads,” says Craythorne. Rosacea often comes with episodes of flushing and persistent redness in the affected areas that can feel hot and stingy. Rosacea can appear around the eyes like PD can, but tends to not manifest until your thirties or later.

• Difference between perioral dermatitis and eczema

“It’s of course possible to develop just dermatitis, as in irritation as a result of some trigger such as aggressive skincare, around the mouth area,” says Craythorne. “In these cases, I would describe it more like an eczema-type of reaction.” If it settles by itself in a few days, or if it goes away fast after applying a topical steroid such as hydrocortisone, “then you know it wasn’t PD to begin with,” she says. Read on for need-to-know information about the link between PD and steroids.

What causes perioral dermatitis?

The exact cause of perioral dermatitis isn’t known. But we know that the vast majority of cases occur in women between 15 and 45. “Even children can get it, but I also see more young teenagers these days, which is definitely due to an obsession with inappropriate skincare,” says Craythorne.

She lists the most common triggers for perioral dermatitis:

• Steroids

Craythorne says it’s clear that among the greatest triggers for PD is long-term use of steroids. By this, she means topical corticosteroids such as hydrocortisone, which you would typically use on a rash or eczema to subdue it, and inhaled steroids such as those in asthma inhalers. If PD is diagnosed, a dermatologist will stop you from using them.

• Too much of the wrong skincare

It’s not to do with ‘natural’ versus ‘synthetic’ skincare but with the surfeit of often inappropriate ingredients, including preservatives, we layer on our skins these days and the biome/barrier disruption this creates. Simply using too many too-harsh ingredients (acids, retinoids) - in the wrong dose and the wrong manner for your type of skin- can disrupt the skin barrier as well, putting you at risk of PD.

• Hormones

Whenever we experience a hormonal shift in life, that’s when PD cases seem to go up. “Think later teenage years, or women who go on pills for PCOS, or taking hormones for IVF or egg collection – these women more often get PD,” says Craythore. The contraceptive pill can be another trigger.

“I also notice it more in patients taking spironolactone for acne, which reduces the testosterone within the skin.” So Craythorne strongly suspects there is a link with hormones “and it is likely to do with the oestrogen/progesterone balance,” she says. But that doesn’t mean PD gets more prevalent in menopause: PD tends to be related to higher levels of hormones rather than lower ones (oestrogen drops in menopause), or to sudden hormonal shifts, she says. “So perimenopause is more of a trigger than menopause or post-menopause.”

• Other triggers

Further triggers for perioral dermatitis are fluorinated toothpaste, the stripping surfactant sodium lauryl sulphate (often found in toothpaste), heavy, oily skincare and makeup (avoid paraffin, mineral oil, plant butter and silicone-based products) and certain sunscreens. Mineral sunscreen may be better (as it is gentler), but only if the texture is light and non-oily.

Can parabens cause perioral dermatitis?

You may be surprised by Craythorne’s, and many other skin doctors’, thoughts on this.

“Applying many layers of skincare means you put a lot of preservatives on your face,” says Craythorne. These used to be mainly paraben preservatives, which, she says, had been so well-studied and used for so long that doctors and formulators “understood their behaviour and the exact way skin responded to them.”

The ‘clean’ beauty movement, however, has vilified parabens (largely erroneously), resulting in them being ostracised from skincare as the public, and then brands, moved to avoid them. “And that's created bit of a problem, as we simply don’t understand the newer preservatives quite as well,” says Craythorne. “There are some theories that these newer preservatives are at the heart of microbiome changes that cause things such as perioral dermatitis.”

In short: an overdose of preservatives may cause PD, but parabens probably don’t.

Can you get rid of perioral dermatitis overnight?

“If it is indeed PD and not regular dermatitis, then the answer is unfortunately no.” says Craythorne.

She says that if you needed to get rid of a little bit of PD (say, before an important function), you could put some steroid cream on it, as “this will get rid of the rash for 24 hours. But you will pay the price as it will come back worse once that steroid has worn off!” she warns.

How do you treat perioral dermatitis?

Once she diagnoses PD, Craythorne advises patients to stop using any topical products in their routine, and to wash simply with water, followed by a super-mild, preservative-free lightweight moisturising cream (see below). She will then use a prescription dose of azelaic acid (in a particular base that is appropriate) or Pimecrolimus cream (an immune-modulating agent often used for eczema), or, in some cases, oral antibiotics until the PD settles. This can take several weeks to months

If you want to try to calm your PD yourself (again, this is a complicated condition that is best treated by a pro), first make sure you cut out all topical or inhaled steroids, and switch to a non-fluorinated, natural toothpaste without SLS. Then cut back your skincare routine to a bare minimum of simple, unfragranced, lightweight products. Try to avoid foundation as well. Often running your pillowcases and towels through a hot wash and avoiding spicy foods are also advised.

Your PD-busting tool kit

La Roche-Posay Toleriane Dermo-Cleanser, £23

A derm favourite, this is super-mild, packed with hydrating glycerine and has only anti-microbial food additive sodium hydroxide to protect against product degradation but sidestep any skin irritation.

By Sarah Maven Daily Moisturiser, £38

Naturals-based and created for exceptionally sensitive skins (even those that are undergoing cancer treatment), this is lightweight, helps heal the skin barrier and only uses a preservative agent that can be used in foods – but it still feels like a luxurious treat

Avene Tolerance Hydrating Hydrating Cream, £20.50

With only ten ingredients (among which no preservatives), this is an ‘exclusion diet’ for upset skin captured in a single skin composition-inspired, biome-friendly moisturiser.

Klira Custom Treatment Formula, from £49

Dr Craythorne’s bespoke skin treatments are based on prescription ingredients and doses and, for PD, will feature things like azelaic acid and ceramides in a fresh monthly delivery.

SOS SPF50 Sun Cream, £17

Preservative-free sunscreens exist but we cannot vouch for the sun-safety of their formulations and they are often very rich. We’d rather recommend this preservative-low, light-feeling, non-irritating broad-spectrum cream.