Perioral Dermatitis

What Is Perioral Dermatitis?

Perioral dermatitis affects the skin about the mouth with pimples and red, scaling patches. It is a disease that affects mainly young women; it is rare in men. Perioral dermatitis may itch or burn, and tends to come and go. Sometimes this rash only involves the skin around the nose or eyes. Perioral dermatitis may spread to the upper cheeks, eyelids, and forehead, and then it’s called “rosaceaform dermatitis.” While cosmetically annoying, perioral dermatitis is harmless and does not scar.

WHAT CAUSES PERIORAL DERMATITIS?

We don’t know why women get perioral dermatitis or why it’s rare among men. Perioral dermatitis is not caused by diet, cosmetics, germs, or viruses, and it is not contagious. Strong cortisone ointments applied to the skin can cause or aggravate perioral dermatitis, even though the rash temporarily improves. When the strong cortisone is stopped, the rash gets worse. Continuing the application of strong cortisone medicines results in a vicious cycle of ever-worsening redness, bumps, scaling, and itching.

TREATMENT

A form of Tetracycline taken by mouth usually produces improvement in 3 to 4 weeks. If you can’t take tetracyclines, other antibiotics by mouth are effective. Why tetracycline works remains a mystery, since perioral dermatitis is not an infectious disease.  There are anti-inflammatory properties to tetracycline like drugs.  So very low dosages may be very effective in treating the dermatitis with minimal side-effects.

Applying medications to the skin is of some benefit but not as effective as antibiotics taken by mouth. I usually begin treatment with an antibiotic by mouth and a metronidazole topical applied to the face twice daily. As the perioral dermatitis improves, the antibiotic is gradually withdrawn to determine whether metronidazole applications will control your rash. If you wish to avoid internal treatment, metronidazole used alone is an option.  It takes at least 6 to 8  weeks for the metronidazole to begin helping.

If you have been applying a strong cortisone to your face, you must stop. Do not resume it even though your rash gets worse. Most flare-ups are temporary and clear after 2 to 4 weeks of antibiotic treatment. If the flare-up is very severe, you may need to take cortisone by mouth for a few weeks.

Perioral dermatitis is unpredictable. It often disappears after 4 to 8 weeks of internal antibiotics. However, some patients need to take their antibiotic much longer. Perioral dermatitis may come back after months or even years. If that happens, resume the treatment that worked before. Remember, don’t use strong cortisone ointments on your face because they can aggravate or cause perioral dermatitis.