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Causes | Diagnosis | Home remedies | Treatment | Duration | Prevention
I was 35 years old when I noticed a cluster of tiny pimples forming around my nose. I treated those little zits as I would any breakout—by exfoliating and slathering my face in creams.
The next day, the entire area was red and raw. In the weeks that followed, everything I attempted to clear my skin—from facials to steroid creams—only made the situation worse.
With the help of Google, I eventually diagnosed myself with perioral dermatitis (also called periorificial dermatitis), an inflammatory skin condition my doctor eventually told me could be common for “women of a certain age.” The small bumps I had mistaken for pimples early on turned out to be pustules. As they popped, these pustules spread the red rash and left my skin dry, red, and flaking.
For seven months, I searched the internet for natural remedies for perioral dermatitis—essential oils, apple cider vinegar, an anti-inflammatory diet, switching to a non-fluoride toothpaste, tossing out my favorite skincare products, eliminating makeup completely—none of it worked. In fact, the rash just got worse, spreading around my nose and mouth and even up to my eyes.
That was when I knew ridding my face of this rash would require more drastic measures. I learned how to cure perioral dermatitis fast by swapping steroids and harsh acne treatments with antibiotics and an anti-inflammatory diet.
Perioral dermatitis causes
“Perioral dermatitis is a relapsing inflammatory skin condition that usually affects the area around the mouth, but can also affect other parts of the face and even the neck and chest in rare cases,” says Todd Schlesinger, MD, a board-certified dermatologist and the head of the South Carolina Medical Association. “It resembles rosacea, but it has a different appearance and location on the skin.”
Perioral dermatitis can actually resemble several skin conditions, including seborrheic dermatitis, atopic dermatitis, allergic contact dermatitis, eczema, and acne vulgaris. This means that making an appointment to seek the help of a dermatologist and get a diagnosis is often necessary.
There is no known exact cause of perioral dermatitis, but experts agree that it most commonly affects young women between the ages of 20 and 45 years. Approximately 90% of all perioral dermatitis cases occur in women between the ages of 18 and 50 years.
While the main cause mostly remains unknown, there are a few possible causes of perioral dermatitis. Hormonal factors may play a role and stress has been associated with relapses of skin rashes in research settings. There are several potential triggers that may make perioral dermatitis worse, including:
- Fluoridated toothpaste
- Steroid creams, including over-the-counter hydrocortisone
- Steroid inhalers
- Steroid nasal sprays
- Birth control
- Acne treatments
- Skincare products
- Anti-aging creams
- Bacterial or fungal infections
How is perioral dermatitis diagnosed?
“Perioral dermatitis is usually diagnosed by a dermatologist looking at its appearance, the location and distribution on the skin and by asking a few pertinent history questions,” says Dr. Schlesinger.
He says that in taking a history, dermatologists can sometimes help patients identify their personal triggers, whether it be certain foods (including certain spices like cinnamon), medications (ibuprofen or other anti-inflammatory drugs), makeup, or fluoridated toothpaste.
“Another common association is with chronic topical steroid use and it has also been reported after the use of nasal steroids or inhalers,” says Dr. Schlesinger.
Perioral dermatitis home remedies
For mild cases of perioral dermatitis, your doctor or dermatologist might recommend making certain lifestyle changes at home to see if you can eliminate the rash on your own. If you can identify the irritant that is causing your rash to flare (like topical steroids) and eliminate that irritant from your daily routine, it is possible to clear up perioral dermatitis without medical intervention.
Natural remedies for perioral dermatitis include:
- Ceasing the use of topical steroids (this may initially make the rash worse)
- Adopting an anti-inflammatory diet to improve gut health
- Eliminating acne treatments and anti-aging products from your skincare routine
- Using a gentle, fragrance-free cleanser and moisturizer formulated for sensitive skin
- Keeping your skin free of makeup until the rash clears
- Switching to toothpaste without fluoride
- Choosing a more natural sunscreen
- Avoiding prolonged exposure to the sun, extreme temperatures, and wind
Consult with your doctor before trying any homeopathic remedies, as some can actually make the condition worse. However, if you have mild perioral dermatitis, especially if you’re able to identify your personal triggers, it is possible to clear perioral dermatitis without medication.
How to treat perioral dermatitis
The American Osteopathic College of Dermatology (AOCD) calls oral antibiotics “the most reliably effective treatment” for perioral dermatitis. The three most commonly prescribed antibiotics for the successful treatment of perioral dermatitis include:
Some doctors may encourage patients to first try a natural treatment plan with elimination practices because treating perioral dermatitis with oral antibiotics typically requires a long course of medication. It’s common to be prescribed anywhere from eight to 12 weeks of daily antibiotics, and those antibiotics sometimes come with their own side effects, including stomach irritation and yeast infections. For more severe cases, though, oral antibiotics tend to be the most surefire way to cure perioral dermatitis fast. “The goal of oral antibiotic therapy is to provide rapid improvement,” according to researchers.
Perioral dermatitis cream
Although the AOCD recommends topical steroid creams be discontinued immediately, as steroid creams can make the condition worse, non-steroidal topical medications can be used with oral medications.
Non-steroidal topical therapies that may be used alongside oral antibiotics include metronidazole gel (an antimicrobial), Elidel cream (pimecrolimus), or topical antibiotics, such as clindamycin lotion and erythromycin cream. Topical Elidel, a calcineurin inhibitor, can be used to treat perioral dermatitis, but it is an expensive option. These topical treatments should be applied as a thin layer to the affected area, usually twice a day. Topical treatments can take up to three months to reach peak efficacy but used alongside oral antibiotics, perioral dermatitis can potentially clear up in a matter of weeks.
RELATED: Metronidazole details | Elidel details | Clindamycin details | Erythromycin details
How long does it take for perioral dermatitis to clear up?
I did everything I could to eliminate triggers at home for half a year and I used a prescription metronidazole cream for months. Nothing had worked, and the rash had only continued to spread. For those of you asking how to get rid of perioral dermatitis overnight, the answer is: you can’t.
My doctor gave me a three-month prescription of doxycycline. My doctor, who had battled her own case of perioral dermatitis in the past, explained that this condition has a way of coming back if you cease treatment before it’s completely gone, so she told me to continue taking the antibiotics for at least two months, or until the rash had been clear for a full two weeks.
She also told me to continue using the metronidazole cream until the rash had cleared.
I started noticing a difference in my symptoms about two weeks into my antibiotics course. The irritation was down and the redness was receding. My skin no longer looked constantly inflamed.
It was about five weeks before the rash had cleared completely, so I continued my antibiotics for the recommended two-month course. After stopping treatment, the rash stayed away.
In the months that followed, I slowly started adding products I had removed back into my skincare routine. I started with eye makeup. And then my favorite exfoliator. And eventually, I felt comfortable wearing a full face of makeup again, without fear of a flare.
I never did add back in my anti-aging creams, though. I decided I’d rather have wrinkles than a rashy face.
How to prevent perioral dermatitis
While similar to perioral dermatitis in its appearance, rosacea differs in that it is a chronic condition with no cure. It may be tempting to treat rosacea with a topical corticosteroid, but there is evidence that use of steroid creams can actually make it worse and lead to corticosteroid-induced rosacea-like dermatitis (CIRD). Perioral dermatitis can fall into the family of CIRD if topical corticosteroids are its cause. Therefore, it is important to not treat rosacea with a topical corticosteroid.
The management of rosacea is best done by avoiding triggers. Triggers vary for each person, so it is important to pay attention to what causes a rosacea flare-up. Potential triggers include:
- Skin, hair, or makeup products
- Stress
- Sunlight
- Heat or cold
- Alcohol
- Spicy foods
If I knew the exact cause of my perioral dermatitis, I might be able to prevent flare-ups better. However, once you’ve had it, there is a strong likelihood it will return at some point. Knock on wood, I’ve made it a year and a half without a recurrence so far.
The best thing you can do to prevent perioral dermatitis is to be gentle with your skin. And to see a doctor immediately if you start to notice a recurrence. The only real regret I have is not considering antibiotics for perioral dermatitis, to begin with. I wouldn’t have had to hide my face from cameras or feel embarrassed to go outside for half a year.
If it ever does come back, antibiotics will be my very first course of treatment.
