What is Periorificial Dermatitis?
Perioral dermatitis (POD) is an inflammatory facial skin condition that typically causes a red rash with small bumps or pustules around the mouth, nose, and sometimes the eyes. Despite its name, it is not related to acne or eczema, although it can resemble both.
It is often itchy, burning, or mildly uncomfortable. The skin immediately around the lips is usually spared, leaving a characteristic clear zone between the lips and rash.
Who gets periorificial dermatitis?
Perioral dermatitis most commonly affects young women aged 15–45, but it can occur in men and children as well. People with a history of sensitive skin or use of topical steroids on the face are more prone.
What causes periorificial dermatitis?
The exact cause is not fully understood, but POD is thought to occur as a result of skin barrier disruption or dysfunction.
It is commonly associated with:
- Topical corticosteroids – especially with prolonged or inappropriate use on the face
- Inhaled corticosteroids – from nasal sprays or asthma puffers
- Heavy/occlusive skincare or makeup products
- Fluorinated toothpaste
- Hormonal changes
- Microbial factors – such as bacteria or skin mites like Demodex
- Environmental triggers – such as UV exposure, heat, or wind
What are the clinical features of periorificial dermatitis?
- Redness and rash around the mouth – Small bumps – papules or pustules often appear in a symmetrical distribution around the mouth and chin. These are often itchy and uncomfortable. The skin can feel dry, and mild flakiness may appear.
- Sparing of the vermilion border – A thin, clear area is typically seen just around the lips.
- Involvement of other areas – The rash can extend to the sides of the nose (perinasal) or even around the eyes (periocular dermatitis).
- Burning or itching – These symptoms are common and may be worsened by moisturizers, cosmetics, or topical steroids.
How is periorificial dermatitis treated?
General Measures
- Cease topical steroids. Steroids may make this condition look slightly better, but are certainly making the condition worse. Unfortunately, some people flare when they stop steroids, but withdrawal is essential for long-term improvement and resolution, and your treating dermatologist can institute actions to counteract this.
- Simplify skincare – Use gentle cleansers and fragrance-free moisturizers. Avoid heavy makeup and skincare products that may irritate the skin.
- Avoid triggers – This includes fluoridated toothpaste, heavy cosmetics, and known personal triggers.
Topical Treatments
These are often the first line of treatment and may include:
- Metronidazole
- Azelaic acid
- Erythromycin
- Pimecrolimus or tacrolimus
Oral Treatments
For more persistent or extensive cases, dermatologists may prescribe:
- Tetracycline antibiotics – e.g. doxycycline or minocycline
- Macrolides – e.g. erythromycin (especially for children or during pregnancy)
This condition can grumble for some time before resolution. Courses of antibiotics usually last 6–12 weeks, depending on the response.
Chronic and refractory cases may respond to low dose isotretinoin.
What is the outcome of periorificial dermatitis?
With appropriate treatment and avoidance of triggers, periorificial dermatitis usually resolves well, and without scarring. However, it may take weeks or months to clear fully. Relapses can occur, especially with re-use of facial steroids. Early dermatological guidance is helpful for optimal long-term control.