Health Education

Perioral dermatitis treatment and medications

Cropped SingleCare logo By | March 26, 2020
Medically reviewed by Karen Berger, Pharm.D.

What is perioral dermatitis? | Perioral dermatitis diagnosis | Perioral dermatitis treatment options | Perioral dermatitis medications | Best perioral dermatitis medications | Side effects of perioral dermatitis | Perioral dermatitis home remedies | FAQ | Resources

Nobody wants to look in the mirror and catch sight of a red, scaly rash taking over their face. But that’s exactly what perioral dermatitis does. What starts as just a few red bumps around the mouth or nose can quickly escalate, spreading across larger areas of skin and growing more irritated even as you try to contain it.

What’s especially frustrating about perioral dermatitis is that the methods you might use to treat other rashes can actually make this rash worse. There’s no reason to hide your face in shame, though—this is one skin irritation that can be kicked with at-home treatment or through the use of topical or oral prescriptions.

What is perioral dermatitis?

“Perioral dermatitis is an inflammatory skin condition that causes redness and bumps around the mouth, along the lower corners of the nose, and sometimes along the lateral margin of the eye,” says Lisa Stirling, MD, a board-certified dermatologist and medical advisor for eMediHealth.

When localized around the eye, the condition is called periocular dermatitis. While perioral dermatitis most often appears on the face, around the mouth and nose, it can also develop on the forehead and even sometimes on the genitals.

The red bumps that appear at the onset of this skin condition are pustular in nature and may be initially mistaken for a small cluster of pimples. But as these pustules spread, the skin becomes dry, red, scaly, and irritated.

“Many dermatologists consider perioral dermatitis as a type of rosacea,” says Austin-based dermatologist Adam Mamelak, MD. “The rash causes reddening and small, pus-filled bumps and mild skin peeling. Other symptoms include dryness, itching, and rashes that resemble acne. Some people may experience burning or stinging at the affected areas, but the rash may also be asymptomatic.”

Dr. Mamelak goes on to say that “perioral dermatitis is most commonly seen in women between the ages of 19 and 40 but can be found across demographics.” When presenting in children, research has found no statistical difference in frequency based on gender or race.

The American Osteopathic College of Dermatology (AOCD) calls perioral dermatitis a “common skin problem” that can be treated effectively.

How is perioral dermatitis diagnosed?

There is no known cause of perioral dermatitis, but it is believed the overuse of inhalers, nasal sprays, and/or creams that contain a corticosteroid may trigger the condition in some cases. Other potential triggers include heavy face creams and moisturizers, skin irritations, and fluorinated toothpastes.

“Perioral dermatitis is usually diagnosed by a dermatologist,” Dr. Stirling says. “The location and morphology are features that help with diagnosis.”

In other words, a dermatologist can typically diagnose perioral dermatitis with an examination alone. There is no need for biopsies or other tests.

Perioral dermatitis treatment options

While there are a variety of treatment options available for perioral dermatitis, it’s important to know what not to try first. People commonly reach for topical steroids at the first sign of a rash, and doing so can be a beneficial treatment for skin conditions like eczema or psoriasis. But for perioral dermatitis, hydrocortisone creams can make the condition worse.

Dr. Stirling explains, “Patients usually have a history of using a topical corticosteroid (such as hydrocortisone), which causes temporary relief followed by rebound and worsening as soon as the topical corticosteroid cream is discontinued.”

If you’ve already started using topical corticosteroids, the first line of treatment is to discontinue use immediately. You might notice your condition could get worse initially, but it’s imperative you don’t revert back to using topical corticosteroids without the explicit direction of your dermatologist to do so.

Treating perioral dermatitis may range from simply changing your skincare products and/or routine to requiring an extended course of oral antibiotics, depending on how severe your case may be.

“The most effective treatments for perioral dermatitis are usually a combination of self-care steps and topical agents for soothing the affected area,” Dr. Mamelak says. He suggests trying to determine what may be contributing to the irritation and removing that from your routine. If you are able to make that determination, he says the rash can often resolve on its own.

However, making that determination isn’t always possible. And sometimes, the rash persists no matter what you remove from your routine. That’s why Dr. Mamelaks adds, “For persistent cases, topical prescription creams and/or oral antibiotics may be recommended.”

Perioral dermatitis medications

If changing your skincare routine and removing potential offending products doesn’t clear up the condition, topical treatments may be prescribed. These perioral dermatitis treatments are anti-inflammatory and allow the skin time to heal. Before using a topical medication, wash the area with a mild cleanser and gently pat dry. After applying the medication, wash your hands. The topical treatments most often recommended for perioral dermatitis include:

  • Metronidazole cream or gel
  • Clindamycin lotion or gel
  • Erythromycin gel
  • Topical sulfur preparations
  • Azelaic acid gel
  • Tacrolimus ointment
  • Pimecrolimus cream

Please note you will need a prescription for most of these options. There aren’t really any over the counter perioral dermatitis treatments. If topical treatments don’t work to resolve the rash, or if your dermatologist determines this is a severe presentation, oral antibiotics may be recommended to address the underlying causes of inflammation, especially when the exact cause isn’t known. The following oral antibiotics may be prescribed for an eight to 12-week course:

  • Tetracycline
  • Doxycycline
  • Minocycline

What is the best medication for perioral dermatitis?

Determining the best course of treatment for perioral dermatitis depends entirely on individual details such as the severity of perioral dermatitis, how it has responded to previous treatments, and what other medications the patient may already be taking.

Best medications for perioral dermatitis
Drug name Drug class Administration route Standard dosage Common side effects
Metrocream
(metronidazole)
Nitroimidazole antimicrobials Topical Applied as a thin layer to the affected area, usually twice daily Skin burning, redness, dryness, irritation, teary eyes
Clindamycin lotion Lincomycin antibiotics Topical Applied as a thin layer to the affected area, usually twice daily Skin burning, dryness, peeling, itching, redness
Ery
(erythromycin)
Topical antibiotics Topical Applied as a thin layer to the affected area, usually twice daily Skin burning, dryness, peeling, itching, redness, tingling
Sulfacetamide sodium Topical antibiotics Topical Applied as a thin layer to the affected area, usually twice daily Skin burning, dryness, peeling, itching, redness, irritation
Finacea
(azelaic acid gel)
Dicarboxylic acids Topical Applied as a thin layer to the affected area, usually twice daily (re-evaluate if not improved in 12 weeks) Skin burning, dryness, tenderness, itching, tingling
Protopic
(tacrolimus)
Topical calcineurin inhibitors Topical Applied as a thin layer to the affected area, usually twice daily (re-evaluate if not improved in 6 weeks) Skin burning, redness, tenderness, increased temperature sensitivity
Elidel
(pimecrolimus)
Topical calcineurin inhibitors Topical Applied as a thin layer to the affected area, usually twice daily (re-evaluate if not improved in 6 weeks) Skin burning, warmth, tenderness, redness, warts, bumps, or other skin growths
Tetracycline Tetracycline antibiotics Oral 250 to 500 mg 2x/day Nausea, vomiting, diarrhea, vaginal itching, anal itching, black/hairy tongue
Vibramycin
(doxycycline)
Tetracycline antibiotics Oral 100 mg 1 or 2x/day Nausea, vomiting, diarrhea, loss of appetite, vaginal itching, anal itching, sore throat, dry mouth
Minocin
(minocycline) 
Tetracycline antibiotics Oral 100 mg 1 or 2x/day Nausea, vomiting, diarrhea, vaginal itching, anal itching, changes in skin color, staining of teeth and gums

Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.

What are the common side effects of perioral dermatitis medication?

Topical treatments for perioral dermatitis carry many of the same potential side effects, including:

  • Skin burning, itching, or redness
  • Dry or peeling skin
  • Skin irritation

These side effects are generally rare, but you should mention them to your dermatologist if you experience any of the above.

The oral medications most often prescribed for perioral dermatitis share common side effects, such as:

  • Nausea
  • Vomiting
  • Diarrhea
  • Itching of the rectum or vagina
  • Dry mouth

More serious side effects for the oral medications most commonly prescribed for perioral dermatitis include headache, blurred vision, hives, swelling of the tongue or lips, peeling or blistering skin, shortness of breath, and unusual bleeding or bruising. If you experience any of these side effects while on these medications, it is important to seek medical attention immediately.

This is by no means an exhaustive list of the potential side effects for all the medications that might be prescribed to treat perioral dermatitis. Patients should discuss the complete list of potential side effects for any medication prescribed with a healthcare provider and read the inserts that accompany those medications completely.

What is the best home remedy for perioral dermatitis?

It is possible to resolve a case of perioral dermatitis at home, without any medical intervention, especially if you only need mild perioral dermatitis treatment. If you’re looking for a natural perioral dermatitis treatment, Dr. Stirling says, “you must simplify and limit the topical products that are used on the face. Using less is better for the skin.”

To simplify your home-based skincare regimen, Dr. Stirling suggests cutting down on:

  • Bar soap
  • Zinc-based sunscreen
  • Argan oil or jojoba oil for moisturizing at night

“I have patients discontinue liquid or foaming cleansers, which commonly contain an irritating ingredient called sodium lauryl sulfate (SLS). Bar soap or oil cleansers are preferred,” Dr. Stirling says.

She says patients attempting perioral dermatitis treatment at home should also avoid:

  • Chemical-based sunscreens, especially those with avobenzone or oxybenzone in the ingredients
  • All acne creams
  • All anti-aging serums
  • Vitamin C Serums
  • Alpha-hydroxy acid-containing products
  • Botanical based ingredients, in particular, any floral natural ingredients such as lavender, chamomiles, rosemary, and calendula
  • Corticosteroids

You may also want to take a break from fluoride toothpastes to see if doing so makes a difference.

The Growing Healthy Together Pediatric Clinic further suggests adding the use of apple cider vinegar (diluted with water), grapefruit seed extract, and/or aloe vera to your routine for at-home care of perioral dermatitis.

“Patients need a month of a very gentle, sensitive skin regimen to heal the skin,” says Dr. Stirling. “If a simple, clean facial regimen does not resolve perioral dermatitis, I recommend an evaluation with a dermatologist. Some patients require prescription topical products and a course of an antibiotic that can decrease the underlying inflammation.”

Frequently asked questions about perioral dermatitis?

What triggers perioral dermatitis?

Potential triggers include:

  • Steroid creams
  • Nasal steroids
  • Steroid inhalers
  • Oral steroids
  • Heavy face creams and moisturizers
  • Makeup
  • Acne treatments
  • Anti-aging creams
  • Skin irritations
  • Fluorinated toothpastes
  • Hormonal changes

Is perioral dermatitis contagious?

According to the American Academy of Dermatology (AAD), perioral dermatitis is not contagious and cannot be spread by skin to skin contact.

Does perioral dermatitis go away?/Will perioral dermatitis heal on its own?

If a patient is able to determine what is irritating their skin and remove it from their routine, perioral dermatitis may clear up without medical treatment.

What does perioral dermatitis look like?

Perioral dermatitis can initially present as small red pustules on the face, most often occurring around the mouth and nose, though patches of perioral dermatitis can be found around the eyes, elsewhere on the face, and even on the genitals. When the rash expands beyond the lower half of the face, it is then referred to as periorificial dermatitis. As the condition worsens, the affected skin appears red, dry and flaky.

Can perioral dermatitis be cured?

Perioral dermatitis can be successfully treated, but may recur at a later date.

What is the fastest way to cure perioral dermatitis?

If you’re looking for the best perioral dermatitis treatment, oral antibiotics have proven to be the most reliable option for quickly eradicating the condition. Consult your healthcare provider, because oral antibiotics are available by prescription only.

Is perioral dermatitis fungal or bacterial?

Perioral dermatitis can be triggered by both bacterial and fungal infections, but it can also be the result of chronic inflammation not related to either.

What is the best cream for perioral dermatitis?

This is dependent upon the severity of the rash and individual patient factors. A dermatologist can determine the best cream for a patients’ unique circumstances.

What is the best way to get rid of perioral dermatitis?

While there are several options for treating perioral dermatitis in adults, oral antibiotics are the best option for eliminating the rash quickly and effectively.

What is the best way to prevent future recurrence?

Dr. Stirling says that patients who have had perioral dermatitis in the past likely have sensitive skin and should only ever add one new skin product at a time. She says, “Use for at least 2 weeks to determine if the skin reacts positively or negatively.”

Related resources for perioral dermatitis?