Perioral Dermatitis Treatments and Medications

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.

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.

“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.

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.”

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:

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.

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.

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:

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.

“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.

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?