ConditionSkin, hair & nails
Perioral Dermatitis
Perioral dermatitis is a common facial rash of small red bumps, sometimes with tiny pus spots and dry flaking, clustered around the mouth, with a characteristic clear band of skin just next to the lips. It can also appear around the nose and eyes (periorificial dermatitis). It mainly affects women aged 20 to 45 and children. The biggest trigger is using steroid creams or inhaled steroids on or near the face. Stopping triggers and a course of topical or oral antibiotics usually clear it within weeks.
Also called: Periorificial dermatitis, perioral rash, periocular dermatitis, steroid rosacea (when steroid-induced)
At a glance
- What it is
- A rash of small red bumps and pustules around the mouth, nose or eyes.
- Key clue
- A narrow rim of normal skin right around the lips.
- Who gets it
- Women aged 20 to 45 most often, and children.
- Main triggers
- Topical or inhaled steroids, heavy creams and makeup, fluoride toothpaste in some people.
- Treatment
- Stop steroids and irritating products ("zero therapy"), topical metronidazole or other creams, oral tetracycline-class antibiotics.
- Time to clear
- Usually 4 to 12 weeks. It may flare at first after stopping steroids.
When to get help
See a doctor within a day or two
- Painful, honey-crusted or rapidly spreading sores around the mouth or nose (possible impetigo)
- Clusters of painful blisters on the lip or around the mouth with fever (possible herpes infection)
- Rash near the eye with eye pain, redness or blurred vision
Book a routine appointment
- A bumpy rash around the mouth, nose or eyes lasting more than 2 weeks
- A facial rash that worsens when you stop using a steroid cream
- A rash around the mouth in a child using a steroid inhaler or nasal spray
Usually safe to manage at home
- A mild rash that improves after stopping heavy creams, makeup and steroid products, using only gentle cleansing
Appearance
- Clusters of small (1 to 2 mm) red or skin-colored bumps
- Small pus-filled spots (pustules) in some cases
- Fine dryness, scaling or peeling
- Redness, sometimes with mild burning, stinging or itching
- Typically around the mouth, in the folds beside the nose, and around the eyes
- A clear zone of normal skin about 5 mm wide directly bordering the lips
- On darker skin, bumps may be flesh-colored or yellow-brown rather than red
In children, the rash is often around the eyes and nose as well as the mouth, and can look granular (yellowish bumps).
Causes and triggers
The exact cause is not fully understood. It appears to involve a disrupted skin barrier and changes in the skin's microbes. Recognized triggers include:
- Topical corticosteroid creams used on the face, including over-the-counter hydrocortisone. This is the most common trigger. Steroids may initially suppress the rash, but it flares when they are stopped, creating a cycle of dependence
- Inhaled steroids for asthma and steroid nasal sprays, especially if residue stays on the skin
- Heavy moisturizers, foundations and night creams, particularly occlusive products
- Sunscreens and cosmetics
- Fluoride toothpaste and some tartar-control toothpastes in some people
- Hormonal changes and oral contraceptives
- Drooling and lip-licking in children
How it differs from similar rashes
| Condition | Distinguishing features |
|---|---|
| Perioral dermatitis | Small bumps around mouth, nose and eyes; clear rim next to lips; no blackheads |
| Acne | Blackheads and whiteheads, often on forehead, cheeks and jaw, more common in teens |
| Rosacea | Flushing, persistent central facial redness and visible blood vessels, usually in older adults |
| Seborrheic dermatitis | Greasy yellow scale in eyebrows, sides of nose and scalp |
| Contact dermatitis | Itchy rash where a product touched the skin, may be blistered |
| Impetigo | Honey-colored crusts, contagious |
Diagnosis
Perioral dermatitis is diagnosed by its appearance and history of steroid or product use. Tests are rarely needed. A swab may be taken if infection is suspected, and patch testing may help if contact allergy is possible.
Treatment
Stop triggers ("zero therapy")
- Stop all topical steroids on the face. If the rash is severe, a doctor may advise tapering to a milder steroid or switching to a non-steroid cream to reduce the rebound flare.
- Stop heavy creams, makeup, foundation and scented products.
- Wash with water or a gentle, fragrance-free cleanser only.
- Rinse the face after using steroid inhalers or nasal sprays, and use a spacer with inhalers.
- Try a fluoride-free toothpaste if other measures fail.
Mild cases may clear with zero therapy alone over several weeks.
Topical treatments
- Metronidazole gel or cream
- Azelaic acid
- Clindamycin or erythromycin
- Pimecrolimus cream, which can speed recovery, especially after stopping steroids
- Ivermectin cream in some cases
Oral antibiotics
For moderate to severe or persistent cases, a course of doxycycline, minocycline or tetracycline for about 6 to 12 weeks is very effective, mainly for their anti-inflammatory effect. Children under 8 and pregnant women are given erythromycin or azithromycin instead, because tetracyclines can stain developing teeth.
What to expect
The rash often gets worse for 1 to 2 weeks after stopping steroids before it improves. This rebound is temporary. Most people clear within 4 to 12 weeks. Recurrences can happen, especially if steroid creams are restarted.
Prevention
- Avoid using steroid creams on the face unless directed by a doctor for a short time
- Use lightweight, non-comedogenic skincare products
- Rinse the face after using inhaled or nasal steroids
- Keep the skin routine simple
Frequently asked questions
What causes perioral dermatitis?
The most common trigger is using steroid creams on the face. Inhaled and nasal steroids, heavy moisturizers, makeup, sunscreens, fluoride toothpaste and hormonal changes can also trigger it. The underlying cause likely involves a disrupted skin barrier.
How do I get rid of perioral dermatitis?
Stop using facial steroid creams and heavy products, and wash only with water or a gentle cleanser. A doctor may prescribe metronidazole, azelaic acid or pimecrolimus cream, or an oral antibiotic such as doxycycline for more severe cases.
How long does perioral dermatitis last?
With treatment, it usually clears within 4 to 12 weeks. It may flare in the first 1 to 2 weeks after stopping steroids. Without addressing triggers, it can last months or keep coming back.
Is perioral dermatitis the same as rosacea?
They are related and sometimes overlap, but they are different. Perioral dermatitis causes small bumps around the mouth, nose and eyes with a clear rim by the lips. Rosacea causes flushing and central facial redness, usually in older adults.
Is perioral dermatitis contagious?
No. Perioral dermatitis is not an infection and cannot spread from person to person. Rashes around the mouth with honey-colored crusts may be impetigo, which is contagious and needs different treatment.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Dermatology: Perioral dermatitis, overview and treatment
- British Association of Dermatologists: Perioral dermatitis patient information
- DermNet: Periorificial dermatitis
- American Osteopathic College of Dermatology: Perioral dermatitis
- MedlinePlus: Perioral dermatitis