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  5. Perioral Dermatitis: Cure, Signs, Risks & Everything You Need To Know

Have you seen anyone with a reddish, ring-shaped rash around their mouth? Or, have you been experiencing it yourself? You should know that it could be a case of Perioral Dermatitis.

Let the name not mislead and worry you, as it is not a serious condition and can be treated. Through this article, know what triggers Perioral Dermatitis, what it looks like and how you should deal with it.

What Is Perioral Dermatitis? Is It Contagious?

A rash that appears on the skin around the mouth is known as Perioral Dermatitis [1]. It is not a contagious condition that can be transmitted from one person to another.

Sometimes, it spreads to the rest of the facial areas such as the eyes or the nose. This is known as periorificial dermatitis.

Sometimes, Perioral Dermatitis can be misdiagnosed due to its appearance. It is mistakenly diagnosed to be acne vulgaris [2], contact dermatitis [3] or rosacea [4]. Unless treatment brings no results, you don’t need to be tested for any of the three conditions mentioned.

Signs And Symptoms Of Perioral Dermatitis

  • The rash is red and has bumps. The bumps are usually reddish and can be scaly too.
  • Sometimes, they may contain pus and look similar to acne.
  • At times, the rash also appears on the forehead and chin areas.
  • Depending on the intensity, it can cause an itching or a burning sensation.

Who & What Age Group Is Most Likely To Be Affected?

Perioral dermatitis may occur at any age regardless of their gender. People of all races and ethnic backgrounds are vulnerable to it. But, it is more commonly seen in teenagers, adolescents and women belonging to the 15-45 age group.

Which Are The Areas Most Affected?

The rash usually appears a few millimetres away from the outside of the lips. It appears like a circular rash around the mouth and sometimes, can spread upwards towards the skin around the nose and eyes.

What Causes Perioral Dermatitis?

There is no known cause for perioral dermatitis. Research and experts indicate that the use of topical steroids on the skin prescribed for some other skin condition could be one cause.

If you are using a nasal spray that has corticosteroids for asthma, it can also be a cause. Topical steroids and corticosteroids containing nasal sprays are known to worsen symptoms or cause an outbreak according to the American Osteopathic College of Dermatology [5]. They recommend discontinuing the use of both after consulting your doctor.

Other causes and factors that may cause perioral dermatitis include fluoride-based toothpastes, chemical sunscreens, birth control pills, certain ingredients in shampoos and cleansers such as sodium laureth sulphate.

Ingredients like petrolatum found in heavy skin creams are also known to cause or aggravate this condition [6]. Even rosacea, bacterial infections and incessant drooling could be a cause.

Treatment Options For Perioral Dermatitis

There are many medical options to treat Perioral Dermatitis. Prevention, natural remedies and avoiding triggers along with medicines can heal you faster. Your treatment options include:

1. Oral Medications

Your dermatologist may prescribe oral antibiotics which include doxycycline [7], minocycline [8] and tetracycline [9]. If your condition is very severe, even isotretinoin [10] could be prescribed. These seem to be the more popular treatment protocols.

2. Topical Antibiotic Medications

Immunosuppressive creams like tacrolimus [11] or pimecrolimus cream [12] have shown positive results in healing Perioral Dermatitis caused by topical steroids.

Other treatments include topical antibiotics such as metronidazole [13], erythromycin [14] or topical anti-acne ointments like azelaic acid [15] and adapalene [16]. Topical azelaic acid is a proven remedy for Perioral Dermatitis.

A formulation created by Dr. Carl Thornfeldt as a remedy for eczema works for patients of Perioral Dermatitis too. It is a combination of zinc pyrithione, salicylic acid and azelaic acid.

3. Face Washes And Moisturisers

Use face washes that are non-foaming and free of sodium laureth sulphate. Moisturisers that are water based, lanolin-free and fragrance-free are best in this condition.

Studies show that squalane oil is an ideal moisturiser for sensitive, inflamed skin. The oil's molecular size is identical to that of the skin’s sebum molecules. Thus, it is absorbed better and is also antibacterial and antifungal in nature.

4. Home Remedies

A. Face Masks:

Experts recommend the use of topical sulphur as a face mask for the treatment of Perioral Dermatitis. Apply on the affected area and leave on for half an hour. Rinse off with warm water.

You can even mix the topical sulphur cream with squalane oil and leave on overnight. Wash off the next morning with warm water.

B. Essential oils:

Our very own Indian neem tree is effective for treating Perioral Dermatitis. Due to its proven antimicrobial, analgesic and antibacterial properties, neem oil [17] can also soothe itching or burning. It can be applied topically, but should be mixed with a carrier oil like coconut oil in a 1:1 ratio.

Neem can be applied to the affected area as an oil and consumed as a supplement. It reduces internal heat from the body and the skin.

Diet And Lifestyle Modifications

Gluten intolerance is a known cause of flare-ups of Perioral Dermatitis.

To control and prevent recurrences, your diet needs more of:

  • Quinoa and millets
  • Broccoli
  • Spinach, Kale and Fenugreek

This is what you need to eliminate from your diet to improve the condition:

  • Alcohol
  • Dairy products
  • Sugar and caffeinated beverages like coffee
  • Spices such as cinnamon
  • Processed foods
  • Excessively spicy and salty food

In your personal hygiene and lifestyle habits, you should:

  • Avoid OTC steroid creams like hydrocortisone.
  • Wash bath and bed linen like towels, bed sheets and pillow covers in hot water weekly.
  • Not use cleansers with artificial fragrances or rough and granulated face scrubs.
  • Shower with warm water, not too hot or cold.
  • Not use too many oil based and heavy creams; opt for water-based ones instead.
  • Minimise the use of cosmetics, sunscreen and make-up items.
  • Wash your face with a hypoallergenic and gentle soap only.
  • Use foaming shampoos that contain sodium laureth sulphate
  • Not scrub your face too hard.

Risk Factors With Perioral Dermatitis

Risk factors that can cause or trigger an outbreak of Perioral Dermatitis include hormonal imbalance, intercourse (women are more susceptible), topical steroid ointments and creams, chronic allergies and the age group (15-45) you belong to.

Tips To Prevent & Manage Perioral Dermatitis

  • As much as possible, avoid applying topical steroid creams on the affected areas, unless prescribed by your dermatologist. If you have been prescribed a topical steroid, ask your doctor to suggest one that is fairly mild. The strong ones can cause or aggravate Perioral Dermatitis.
  • If you are taking oral contraceptives to prevent a pregnancy or for other health reasons, check for zinc deficiency. Take a zinc supplement after a meal, especially if you are on birth control pills.
  • Minimise the use of cosmetics.
  • Use water-based skincare creams and lotions.
  • Choose hypoallergenic, fragrance-free products for your skin and hair.
  • Protect your skin from the sun with hats, scarves and shades as sunscreen can also cause problems.
  • If you are under high stress and you have chronic Perioral Dermatitis, your flare-ups will increase. In cases of chronic PD, we can see flare-ups more often in periods of high stress.
  • Going on a carbohydrate free diet that is low GI and high protein, especially if you don’t have a gluten intolerance, can significantly improve the symptoms of Perioral Dermatitis. It can reduce dependence on medication and result in fewer outbreaks.
  • If you are dark skinned, topical metronidazole and a carbohydrate free diet will reduce your symptoms and frequency of Perioral Dermatitis.
  • Eating cooling foods that can cause a cooling effect on the body and practicing calming habits such as yoga or meditation can also help.
  • Include probiotics in your diet and do away with the heavy creams and oils to prevent symptoms from getting worse.
  • If you have Perioral Dermatitis, you should not exfoliate your face. It aggravates the problem and makes it worse.

What Foods Trigger Perioral Dermatitis?

An undiagnosed allergy or intolerance of gluten is one of the main foods that trigger Perioral Dermatitis. Switching to a gluten-free diet, preferably low carb or carb-free diet that is high protein, has shown improvement in the condition.

Why Is My Perioral Dermatitis Getting Worse?

Self-medication, especially corticosteroid creams that may provide relief initially, can lead to an aggravation of the condition, when discontinued. Other aspects that make it worse are an unhealthy gut, a poor, imbalanced diet and stress.

How Long Does It Take For Perioral Dermatitis To Clear Up?

The rash takes a while to clear up. With the right kind of treatment, a flare-up can take anything from a few weeks to a few months, depending on its severity. Sometimes, due to triggers and incorrect medication, it can recur.

Does The Sun Make Perioral Dermatitis Worse?

Yes, the sun is a known trigger. The UV rays, excess heat and the environment can lead to a flare-up. In fact, some of the medicines prescribed to treat perioral dermatitis can also make your skin extra sensitive to the sun.

What Irritates Perioral Dermatitis?

There are a range of triggers that can cause an outbreak of perioral dermatitis. From oral contraceptives to fluoride in toothpaste; a steroidal cream or ointment used on the face, cosmetics and cleansers if applied to the area with the rash, and stress can make it worse.

Wrapping Up

Perioral Dermatitis is a condition often triggered by stress or the use of topical steroids. If you change your diet, and work on making your life as stress free as possible, you can reduce its frequency and with the right remedies, get rid of it completely.

Begin By Knowing Your Skin