Perioral Dermatitis
Small red bumps and flaky skin around the mouth, sometimes the nose or eyes, often sparing a thin rim by the lips. Usually triggered by steroid creams or heavy face products. Not contagious.
Quick answer: The first treatment for perioral dermatitis is “zero therapy”: stop steroid creams and most face products, and wash with water or a gentle cleanser. Many rashes clear over weeks to months. If not, a GP may suggest azelaic acid or an antibiotic cream, or a 6–8 week course of antibiotic tablets for stubborn rashes.
The perioral dermatitis ladder
Step 1 clears many rashes on its own. Expect it to look worse before it looks better. Give treatments 6 to 8 weeks.
- Step 1 · Self-care“Zero therapy”: stop the steroid cream and most face productsWater or a gentle soap-free cleanser, and not much else for a while.
- Works
- No trials, but most rashes clear on their own over weeks to a few months; sensible first step
- Cost
- Free. Actually saves money
- How long
- Weeks to a few months
- Watch for
- A rebound flare for 1–2 weeks after stopping a steroid cream. Normal. Don’t restart it.
Your nine-step skincare routine has been asked to sit this one out.
- Step 2 · PharmacyAzelaic acid creamA gentle anti-inflammatory cream. Suitable in pregnancy.
- Works
- Evidence weak (small studies only), but gentle and low risk
- Cost
- About $25–45 a tube
- How long
- 4–8 weeks to judge
- Watch for
- Stinging or itching at first.
Gentle doesn’t mean fast. It means it won’t start a fight.
- Step 3 · PrescriptionAntibiotic gel or cream (metronidazole or erythromycin)Twice a day for milder rashes, used for its anti-inflammatory effect.
- Works
- Small trials: erythromycin speeds clearing, though more slowly than tablets; metronidazole evidence is weak
- Cost
- About $40–70 a tube on a private script
- How long
- Up to 8 weeks
- Watch for
- Can sting sensitive skin.
Thin layer. You’re treating skin, not icing a cake.
- Step 4 · PrescriptionPimecrolimus creamA non-steroid prescription cream that can ease the flare after stopping a steroid.
- Works
- Small trials: calms the rash faster in the first weeks, but doesn’t clear it any sooner overall
- Cost
- About $40–70 a tube on a private script
- How long
- A few weeks
- Watch for
- Warmth or burning at first, usually settles.
All the calm, none of the steroid rebound drama.
- Step 5 · PrescriptionAntibiotic tablets (doxycycline or similar)For moderate or stubborn rashes, used for their anti-inflammatory effect. Erythromycin for under-8s and in pregnancy.
- Works
- Best evidence of any option: trials show faster clearing; most rashes clear within 2–3 months
- Cost
- About $15–30 a month
- How long
- 6–8 weeks
- Watch for
- Sun sensitivity, nausea, heartburn if taken lying down. Doxycycline not in pregnancy or under 8.
Big glass of water, stay upright. Your oesophagus will thank you.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Hydrocortisone and other steroid creamsCalm it for a few days, then make it worse. Often the cause, never the cure.
- Tea tree and essential oilsNo good evidence, and a common cause of irritated, allergic skin.
- Antifungal creamsLittle evidence, unless a doctor thinks yeast is involved.
- Fluoride-free toothpasteBased on case reports only. Cheap enough to try, but don’t expect miracles.
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. A light gel sunscreen is fine.
- Expect a flare for 1 to 2 weeks after stopping a steroid cream. Hold your nerve.
- Once clear, bring back one product a week and ditch 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.
Common questions
What causes perioral dermatitis?
It is commonly triggered by steroid creams or heavy face products. It is not contagious.
How long does perioral dermatitis take to clear?
Many rashes clear over weeks to a few months after stopping steroid creams and most face products. If needed, antibiotic tablets or creams are used for 6 to 8 weeks.
Why did my rash get worse after stopping steroid cream?
A flare for 1 to 2 weeks after stopping a steroid cream is normal. Don’t restart it, and see your GP if you’ve been using a strong one.
What is the best treatment for perioral dermatitis?
Start by stopping steroid creams and most face products (“zero therapy”); many rashes clear over weeks to months. If it doesn’t settle, a GP may suggest azelaic acid, metronidazole or erythromycin cream. For moderate or stubborn rashes, a 6 to 8 week course of antibiotic tablets such as doxycycline has the best evidence.
Helpful resources
- healthdirect: Seeing a dermatologistWhat a dermatologist does, costs, referrals and how to find one near you. Free, Australia.
- MedlinePlus: Perioral dermatitisShort, plain-language summary, including why to avoid steroid creams on the face. Free, US.
Evidence and more information
- British Association of Dermatologists: Peri-oral dermatitis
- ACD: Perioral dermatitis
- Hall & Reichenberg: Evidence-based review of perioral dermatitis therapy (2010)
maladywise.com/perioral-dermatitis/