What is Perioral Dermatitis?
Perioral dermatitis is a common inflammatory condition that often appears as small pink bumps around the mouth and sometimes near on or near the eyelids.
What Causes Perioral Dermatitis?
Many things can trigger perioral dermatitis including:
Topical Steroids: Use of topical corticosteroids, such as hydrocortisone, can initially help this condition, but also can cause perioral dermatitis.
Fluorinated & Other Toothpaste: Fluoride in toothpaste "may" irritate the skin and trigger perioral dermatitis. Tartar control and other special formulations may irritate the skin. This is very common.
Nasal Steroids: Inhaled steroids used for asthma or seasonal allergies can also trigger perioral dermatitis.
Hormonal Changes: Fluctuations in hormone levels, such as during pregnancy or while taking birth control pills, can increase the risk of developing perioral dermatitis.
Cosmetic Products: Certain cosmetic products, such as moisturizers, foundations, and lip balms, can contain ingredients that irritate the skin and trigger perioral dermatitis.
Other Triggers: Other potential triggers include stress, heat, sun exposure, and certain medications (e.g., lithium, tetracycline).
How do you treat perioral dermatitis?
First and foremost, any triggers must be avoided. We recommend changing toothpaste to a natural one, such as Tom's fluoride free, or old-fashioned Crest, which does have fluoride.
Oral doxycycline is commonly prescribed for moderate to severe cases and is very effective. It is generally taken for 6 or more weeks.
Topical non-steroidal anti-inflammatory ointment, Tacrolimus, can be used for mild cases and is fairly effective.
Topical antibiotics reduce inflammation and can be helpful in mild cases. Topical clindamycin, sulfa, or metronidazole have all been used with mixed results.
What to expect with treatment?
Be patient! Things are not going to go away in a week or two. Mild cases can resolve in 3-6 weeks, moderate cases in 4-8 weeks, and severe cases can take longer.
How long do I have to be on medication for perioral dermatitis?
Treatment is continued until one is completely cleared. At that point, one is usually tapered off the medications over 2-6 weeks.
For oral medications, it is reduced to once a day then stopped.
For topical medications that are applied twice daily, one reduces it to once daily then stopped.
Once the trigger is removed the dermatitis will resolve and often does not return unless the trigger is reintroduced.
Some patients may develop rosacea, which has some similar treatments to perioral dermatitis.