Perioral Dermatitis

Perioral Dermatitis

  • Best Results2-6 weeks
  • Treatment RecoveryNA
  • Procedure TimeNA
  • Skin SpecialistDermatologist
  • Duration of ResultsLong lasting
  • AnaestheticNA
  • Back to WorkNA
  • Cost$

Perioral Dermatitis

Perioral dermatitis or POD is the most common inflammatory rash seen by dermatologists. It is also termed steroid induced rosacea.  I used to treat half a dozen cases daily when I practiced medical dermatology in the mid 2000s. This condition is easy to diagnose, & in most cases, even easier to treat. Be guided by your dermatologist.

FactsFacts on Perioral Dermatitis

  • This is the most common rash seen by dermatologists
  • It presents as tiny bumps around the nose, mouth & occasionally eyes
  • The most common cause are steroid preparations
  • Treatment is simple. Stop all your skincare actives
  • Stop sunscreen application for one week; minimise makeup
  • Take some prescribed anti-inflammatory tablets for 4 to 6 weeks
  • Gradually re-introduce appropriate skin care once your rash settles
  • A minimalistic approach to skin care is advised

What is Perioral Dermatitis or POD?

This is a very common rash that occurs around the nose & mouth area, hence the name perioral. It can also affect the eye area (periocular dermatitis). The onset is insidious & however, it can be persistent & resistant to over-the-counter creams. POD looks like tiny red dots most often with slight scaling. It is frequently confused with eczema or fungal acne.

What causes POD?

In some cases, the causative agent is straightforward- usually a steroid cream (Sigmacort, Elocon, Betnovate, Novosone) or an antifungal like Kenacomb. In others it is secondary to eczema creams like Elidel or Protopic. This is termed steroid induced acne.

Other cases are multifactorial, including too much skin care actives, occlusive topicals, leaving on makeup too long, not letting your skin breathe enough or, most often a combination of the above. The good news is that the diagnosis is straightforward as is the treatment. 

What is the treatment?

If you want a fast and effective fix, a course of anti-inflammatory antibiotics will sort out 90% of perioral dermatitis. First line treatments include doxycycline 50 -100mg, minocycline 50-100 mg, & erythromycin 400 -800mg twice a day. Your rash will start to improve within 2-3 weeks, albeit a purge period of 1-2 weeks in some cases (steroid induced POD). You should continue these tablets for 6-8 weeks. 

Disclaimer: I do not treat rashes, including perioral dermatitis. See a medical dermatologist.

What is the best skincare routine when treating perioral dermatitis?

A minimalistic one. This means put all your skin care products on hold for the next few weeks. Your treating dermatologist will have their own guide. A simple formulated routine looks like this-

AM: Wash with Cetaphil, QV Gentle wash, or La Roche Posay Toleriane. Skip sunscreen application for 5-8 days. Use a light moisturizer, eg. La Roche Posay Ultra-Light Daily Moisturizer.

PM: Wash with above. Option to add azelaic acid 15% at week two. Moisturise as above.

Stop all actives including retinol, ascorbic acid, AHAs, BHAs, pigment correctors, soaps, toners, essential oils, & occlusive moisturisers. Stop all prescription medications unless directed to do so by your dermatologist. Ideally stop makeup & sunscreen for one week.

Why should you continue your anti-inflammatory medications for 6 weeks?

Because research has shown that a prolonged course of doxycycline, minocycline or erythromycin gives the best results. You can stop earlier, but your remission rate is markedly reduced.

Davin’s Viewpoint on treating perioral dermatitis

It’s a paradox. The treatment is simple enough, but the cause of perioral dermatitis remains a true mystery. Aetiology ranges from simple cause & effect, namely corticosteroids, to more controversial theories ranging from demodex, c. acnes, light, heat, occlusion, genetics, & preservatives. Not to forget the universal stress & diet.

Most causes of POD are non-specific & goes something like this; you see a GP for some rash (probably mild seb derm or irritant contact dermatitis), they prescribe you some steroid like Sigmacort, Elocon, Betnovate or Desowen. The rash goes. Then a few days later it comes back, you start back with the steroids then the rash goes away (for lesser duration with time). The cycle continues, then bam! You’re a steroid loving junkie.

The solution is not hard (in 96% of the time), stop the steroid, take doxycycline for 6 weeks, cease application of makeup (for the first 2 weeks) & suck up any purges & flares. In the majority of cases, it goes & won’t return. For those who suffer chronic perioral dermatitis the primary reasons are –

  1. You have not taken your anti-inflammatory meds long enough.
  2. You are using the incorrect skin care-too much occlusion- too many actives.
  3. You are applying the wrong makeup. Or too much.
  4. The diagnosis is incorrect.
  5. It is chronic just because you are unlucky. 

For those people who are prone to POD, being a skincare junkie will not help the cause. The solution, believe it or not, is the mantra that less is more. Less stuff on your face, the better your skin gets. Anti-aging, anti-wrinkle, anti-pigment? Go lasers & injectables over topicals and peels. Still not convinced. Go simple skincare for 4 weeks and find out.

A dermatologist can work out a differential for persistent cases of POD, including acne, skin allergies, rosacea, in particular granulomatous subtype, lupus miliaris, adnexal tumours (late onset trichoepitheliomas, atypical syringomas) & others.

Disclaimer: I do not treat perioral dermatitis. I may give a second opinion if called upon by my colleagues at Clinic Cutis, but I will not take on management. My skill sets and interests are complex procedural cases.

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