Perioral dermatitis
Created: 09.01.2025
Updated 30.03.2026
Approved by: Consultant Dermatologist, Dr James Denny
What is Perioral dermatitis?
Perioral dermatitis is an inflammatory facial rash that typically appears around the mouth. It presents as red or pink patches with small acne-like bumps and can resemble a combination of eczema and acne.
It most commonly affects women between the ages of 20 and 50, although men and children can also develop perioral dermatitis. The condition is not contagious and is not caused by poor hygiene.
The exact cause is not fully understood. However, there is a strong association with the use of topical corticosteroids, including mild over-the-counter hydrocortisone creams. In some cases, inhaled or oral steroids can also trigger or worsen perioral dermatitis.
Other recognised triggers include:
- Heavy facial moisturisers and cosmetic products
- Certain sunscreens
- Fluorinated toothpaste
- Occlusive skincare products
- Hormonal factors
Although bacteria may contribute to inflammation, perioral dermatitis is not considered a primary bacterial infection.
What are the symptoms?
Perioral dermatitis typically begins as redness around the mouth, often sparing a narrow strip of skin immediately next to the lips.
Common symptoms include:
- Red or pink inflamed patches
- Small raised bumps known as papules
- Occasionally small pustules
- Dry, flaky, or scaly affected skin
- Burning, stinging, or mild itching
Although the rash most often surrounds the mouth, it can also affect the nose, cheeks, eyelids, and area around the eyes. When it involves the eye area, it is sometimes referred to as periorificial dermatitis.
Unlike acne, blackheads are not typically present. The condition can fluctuate, with periods of improvement and flare-ups.
Why do people develop perioral dermatitis?
The development of perioral dermatitis is thought to involve a disruption of the skin barrier combined with immune and inflammatory changes.
Several factors increase the risk:
- Prolonged or repeated use of topical corticosteroids
- Overuse of heavy skincare products
- Previous history of eczema or sensitive skin
- Hormonal influences
- Environmental factors
Topical corticosteroids are a particularly important trigger. While they may temporarily improve redness, stopping them often leads to a rebound flare that can worsen perioral dermatitis. This cycle can make the condition difficult to control without specialist guidance.
How is perioral dermatitis diagnosed?
Diagnosis is usually made clinically by a dermatologist based on the pattern and appearance of the rash.
A skin biopsy is rarely required but may be considered if the presentation is atypical or if other conditions such as rosacea, acne, seborrhoeic dermatitis, or contact dermatitis need to be excluded.
Careful assessment is important to ensure the correct diagnosis and to avoid inappropriate treatments that could aggravate the condition.
Treating perioral dermatitis
Effective management requires a structured approach. Early specialist assessment improves outcomes and reduces the risk of prolonged symptoms.
1. Stop triggering products
The first step in treating perioral dermatitis is to discontinue topical corticosteroids and unnecessary facial products. This is sometimes referred to as a “zero therapy” approach.
Patients should:
Stop topical steroid creams, including mild hydrocortisone
Avoid heavy moisturisers and occlusive creams
Use gentle, fragrance-free cleansers
Reduce makeup and cosmetic use
It is important to note that symptoms may temporarily worsen after stopping steroids before improvement occurs.
2. Topical medications
For mild to moderate cases, specific topical medications such as antibiotic or anti-inflammatory creams may be prescribed. These reduce inflammation and help restore the skin barrier.
3. Oral treatment
For more persistent or widespread cases, a course of oral antibiotics may be recommended. These medications are used for their anti-inflammatory properties rather than to treat a bacterial infection.
Treatment typically continues for several weeks, and completing the full course is essential to reduce recurrence.
What can worsen perioral dermatitis?
Several factors can worsen perioral dermatitis:
- Continued use of topical corticosteroids
- Over-cleansing or scrubbing the skin
- Using fragranced or irritating products
- Reintroducing triggering cosmetics too soon
- Not completing prescribed treatment
Close follow-up with a dermatologist helps ensure treatment is adjusted appropriately and relapse is minimised.
What is the prognosis?
With appropriate treatment, most patients see significant improvement within 6 to 12 weeks. Early specialist care reduces the risk of prolonged inflammation and potential post-inflammatory pigmentation changes.
Recurrence can occur, particularly if triggering products are restarted. However, with correct management and education, long-term control is usually achievable.
Left untreated, perioral dermatitis may persist for months or even years and can affect confidence and quality of life. Early diagnosis and structured treatment significantly improve outcomes.
Frequently Asked Questions
Is perioral dermatitis caused by topical corticosteroids?
Topical corticosteroids are one of the most common triggers. While they may temporarily reduce redness, they often worsen perioral dermatitis over time and can cause a rebound flare when stopped. Medical guidance is important when discontinuing steroid creams.
How long does perioral dermatitis take to clear?
With appropriate treatment, most patients improve within 6 to 12 weeks. Recovery can take longer if the condition has been present for some time or if topical corticosteroids have been used repeatedly.
Is perioral dermatitis a bacterial infection?
No. It is not considered a primary bacterial infection. However, certain antibiotics are used in treatment because of their anti-inflammatory effects rather than their antibacterial action.
Can I continue using my usual skincare products?
In most cases, simplifying your routine is essential. Heavy moisturisers, fragranced products, and certain cosmetics can worsen perioral dermatitis. A dermatologist can advise on safe, gentle products while the skin heals.
When should I see a dermatologist?
You should seek specialist advice if the rash persists, spreads to the eyes or nose, worsens despite stopping steroid creams, or keeps recurring. Early assessment helps confirm the diagnosis and ensures appropriate treatment.
