Perioral dermatitis: what to change in your skincare and when to see a dermatologist

SKIN CONCERNS

What is perioral dermatitis, and how is it different from dry skin around the mouth?

Perioral dermatitis – known in everyday German as Mundrose – is an inflammatory skin condition with small red bumps, sometimes pustules and fine flaking around the mouth and nose, and occasionally around the eyes. A typical sign is a narrow strip of skin right along the edge of the lips that stays clear while the skin next to it is red. In its patient information, the British Association of Dermatologists describes it as a common skin condition that more often affects women between 20 and 50, whatever their skin type. Dry skin around the mouth looks different: it feels tight, flakes finely and feels rough, but it does not form bumps or pustules. If all you have is flaking and a feeling of tightness, start by reading what helps with dry skin around the mouth. Once bumps appear, it is no longer a question of finding the right cream.

The overview below is not a substitute for a diagnosis. It only helps you judge whether there is something you can change yourself or whether your skin belongs in professional hands.

Because the three can overlap, it is also worth reading about rosacea skincare if the redness persists. Telling them apart, however, is a job for your appointment.

What role do cosmetics, steroid creams and too many layers of skincare play?

Steroid creams used on the face are considered the main trigger of perioral dermatitis, while cosmetics and multiple layers of skincare are common aggravating factors. A systematic review in the Journal of Cosmetic Dermatology found the strongest evidence for misuse of topical corticosteroids as the principal cause. At the same time, the authors point out that how the condition develops is not yet fully understood. The catch with steroid cream on the face is that it visibly calms the skin at first – which is exactly why so many people reach for it again as soon as the bumps return. The result is a cycle that is hard to break on your own.

With cosmetics, it is less about any single product than about the total. In an Australian case-control study in the Australasian Journal of Dermatology, using foundation, moisturiser and night cream together was linked to a 13-fold increased risk, whereas a moisturiser on its own was not. The authors suspect an occlusive effect, in other words too many sealing layers on top of one another. How to recognise patterns like this more generally is covered in the article on skincare overload.

When should you see a dermatologist about perioral dermatitis?

You should see a dermatologist as soon as you suspect perioral dermatitis, not only once your own attempts have failed. The reason is simple: rosacea, a contact allergy, acne or eczema can look similar around the mouth, yet each needs something different. A wrong guess costs you weeks. You should definitely book an appointment if you have ever used a steroid cream on your face or are using one now, if the bumps spread to your nose or the area around your eyes, if a child is affected, or if nothing improves even though you have cut your skincare right back.

Prepare for the appointment by writing down every product that has ended up on your face in recent months: creams, serums, make-up, sunscreen, lip balm, toothpaste and, above all, any ointment that was ever prescribed or recommended to you. Photos from different days help, because the skin can change quickly. The more complete the list, the faster it is to narrow down what is irritating your skin. Whether you need treatment, and which one, is decided by a professional, not by a product off the shelf.

What is so-called zero therapy, and why does it need medical supervision?

By zero therapy, professionals mean temporarily leaving out all products on the face so that the skin can settle without any new irritants. A review in Acta Clinica Croatica describes it as the treatment of choice for mild forms. In its patient information, the British Association of Dermatologists advises stopping all face creams, including steroids and cosmetics, unless your healthcare professional says otherwise, and washing your face with water only until the condition clears.

The same review explains why it is still not a do-it-yourself project: anyone who has previously used steroids should be closely followed up at first, because the skin usually gets temporarily worse after stopping – a so-called rebound. The UK’s Primary Care Dermatology Society adds that after stopping suddenly, the spots may get worse for a few days before they settle. This is exactly the phase in which many people reach for the ointment again. On top of that, zero therapy only makes sense with the right diagnosis. With eczema or an allergy, your skin may need something entirely different. So how long, how strict and with what support is something you decide together with your dermatologist.

Which skincare habits should you drop while your skin is irritated?

While your skin is irritated, leave out anything that adds irritation or seals the skin, and discuss everything else with your doctor. To many people this feels wrong, because the reflex with irritated skin is to reach for a new, soothing product. With perioral dermatitis, though, the sheer number of products is part of the problem. These are the habits to put on hold for now:

• Fragrance and essential oils, including in lip balm, cleanser and facial oil. What really counts on the packaging is explained in the article on fragrance-free moisturiser.
• Make-up and foundation on the affected area, as well as extra layers of sunscreen. What exactly to do about sun protection is something to clarify with your dermatologist.
• Exfoliants, fruit acids and retinoids – even if they are only meant for your forehead and cheeks and travel down to your mouth as you spread them.
• Heavy, occlusive layers such as rich night creams, balms or several creams on top of one another.
• Steroid cream on your face without a doctor’s instructions. An ongoing treatment, however, is not something to stop on your own – only after talking it through with your doctor.

How do you rebuild your skincare after healing without triggering a relapse?

Once your skin has healed, rebuild your skincare slowly and one product at a time, starting with a single fragrance-free cream – and only when your doctor gives you the go-ahead. After the condition has cleared, the British Association of Dermatologists recommends a soap substitute as advised by your healthcare professional and, for dry or sensitive skin, an unperfumed moisturiser. The Primary Care Dermatology Society mentions a light, oil-free moisturiser, applied thinly, if the skin becomes too dry. The British Association of Dermatologists also notes that the skin usually stays clear as long as steroids are avoided on the face, but that the condition sometimes comes back. Test each new product on a small area away from your mouth for a few days first, then wait one to two weeks before adding the next. That way, if your skin reacts, you know where the reaction came from.

In the long run, what protects you most is a short routine. Fewer layers mean less occlusion and fewer potential irritants. Just how little that can be is shown in the article on how many products your skin really needs. If your skin still stings or feels tight easily after healing, a damaged skin barrier is often behind it, and that needs time. One option for getting back into skincare is The Duo, with just two fragrance-free products: The Essential with hyaluronic acid and niacinamide, and The Shield with ceramide NP and squalane. Because The Shield also contains lipids in the form of squalane and jojoba oil, check with your doctor beforehand whether a cream like this is right for you yet. Introduce the two separately, each with a patch test. The Duo does not work against perioral dermatitis; it is skincare for the time afterwards.

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