Perioral Dermatitis

The most common trigger by far is a steroid cream used on the face. This includes creams prescribed for another condition and mild hydrocortisone bought over the counter. The steroid makes the skin look better for a few days, then worse, and the rash keeps returning for as long as it is used.

Inhaled and nasal steroids for asthma, hay fever or rhinitis can do the same thing, particularly where the spray settles around the mouth and nose. Heavy or occlusive moisturisers, thick foundations, fluoridated toothpaste and some cosmetics are also associated with it.

Hormonal factors may play a part, which is one reason it is more common in women of childbearing age. In a good number of people no single cause is ever identified.

Perioral dermatitis is not an infection and you cannot pass it on. Identifying and removing your own trigger is the single most useful thing you can do, and for most people that means stopping any steroid on the face.

• Clusters of small red bumps and pustules around the mouth, and sometimes beside the nose or around the eyes
• A mildly red, slightly scaly background to the rash
• A narrow rim of normal skin immediately bordering the lips, which the rash spares
• Burning, stinging or a tight feeling rather than itching
• Dryness and flaking, which can be worse if you have been using a steroid cream
• Flares that settle briefly with a steroid and then return worse than before
• No blackheads or whiteheads, which is what separates it from acne
  
  

Symptoms vary from person to person. If your eyes are gritty, sore or watery, if the rash is weeping or crusting, or if you feel unwell with it, see your GP or a dermatologist in person rather than treating it online.

Perioral dermatitis responds well to treatment, but it needs a clear plan and some patience. Treatment depends on how widespread the rash is and what triggered it, and usually combines stopping the cause with a prescribed medicine.

Stopping the trigger

If you have been using a steroid cream on your face, stopping it is the most important step. Expect the rash to flare for two to four weeks afterwards before it starts to settle. This is normal withdrawal, not treatment failure, and the medicines below are partly there to shorten it.

Topical Treatments

Applied directly to the skin, and usually the first choice for mild to moderate cases.

• Metronidazole 0.75% gel or cream (Rozex) – a topical antibiotic that calms inflammation
• Azelaic acid 15% gel (Finacea) – a non-antibiotic option with no resistance risk and no 12-week cap
• Erythromycin with zinc (Zineryt) – an alternative topical antibiotic solution
• Pimecrolimus 1% cream (Elidel) – an anti-inflammatory that is neither a steroid nor an antibiotic

Oral Medications

Added for moderate, widespread or stubborn rashes, or where a topical alone has not been enough. Antibiotic courses normally run from 4 to 12 weeks. 

• Doxycycline 100mg – taken once a day, the most widely used option
• Lymecycline 408mg – taken once a day, generally less likely to cause sun sensitivity
• Erythromycin 250mg – taken as two tablets twice a day
  
  

Skincare and lifestyle

Keep your routine simple while the rash settles. Use a plain, fragrance-free moisturiser and a daily SPF, and avoid scrubs, astringents, heavy occlusive products and thick make-up. Once it has cleared, avoiding steroid creams on the face is the best way to stop it coming back.

A note on licensing

No medicine currently holds a UK licence specifically for perioral dermatitis, so every treatment on this page is prescribed off-label. That means the prescriber is using it outside the terms of its licence because the clinical evidence supports doing so. You will be asked to confirm you understand this during your consultation.