Perioral Dermatitis
Clusters of small red bumps and flaky skin around the mouth, and sometimes the nose or eyes, often sparing a thin band next to the lips. Commonly triggered by steroid creams or heavy face products. Not contagious.
First step: "zero therapy". Stop steroid creams and as many face products as you can. Many rashes clear with this alone over a few weeks.
Treatment options
Ratings show how strong the research is.
- Moderate evidenceAntibiotic tabletsDoxycycline or similar for 6 to 8 weeks, used for their anti-inflammatory effect. Erythromycin for children under 8 and in pregnancy.
- Moderate evidenceAntibiotic cream or gelMetronidazole or erythromycin, twice daily for up to 8 weeks. For milder rashes, but can sting sensitive skin.
- Moderate evidencePimecrolimus creamA non-steroid prescription cream. Can ease the flare after stopping a steroid.
- Limited evidenceAzelaic acidA gentler cream that may help. Suitable in pregnancy.
- Not recommendedSteroid creams on the faceMay help for a few days, then the rash rebounds worse. Don’t restart them.
What you can do
- Wash with water or a gentle soap-free cleanser, then rinse well.
- Pause make-up, thick creams, ointments and fragranced products. Use a light gel sunscreen if needed.
- Expect a flare for 1 to 2 weeks after stopping a steroid cream. This is normal.
- Once clear, bring back one product a week and drop any that cause a flare.
- Rinse your mouth and face after steroid inhalers or nasal sprays, and keep using them.
See your GP if
- You’ve been using a steroid cream on your face (strong ones may need tapering)
- No better after 2 to 4 weeks of "zero therapy"
- The rash is around the eyes or keeps coming back
Don’t stop asthma inhalers or prescribed steroid tablets without talking to your doctor. See a doctor the same day for a painful red eye or blurred vision.
Evidence and more information
- DermNet: Periorificial dermatitis
- British Association of Dermatologists: Peri-oral dermatitis
- ACD: Perioral dermatitis
maladywise.com/perioral-dermatitis/