Having a rash anywhere on your body is never ideal, but one that frames your mouth and nostrils seems particularly cruel. Even worse are the horror stories that have appeared in our DM’s of women mistaking perioral dermatitis as congestion or acne.
Imagine slapping Benzac or salicylic acid on eczema…. OUCH.
We always recommend talking to your dermatologist if you have regular flares of any variety. However, we understand that often it can be difficult to gain an appointment when your flare is at its worst (take photos!) So we, with Dr Katherine Armour, have put together a guide to help you recognise signs and symptoms of perioral dermatitis and what you can do at home to minimise flares.
Signs you may have perioral dermatitis
Perioral dermatitis (also sometimes called periorificial dermatitis) can be a complex condition to diagnose, even for doctors, as it looks and behaves like a confused mix of eczema, acne and rosacea. However, there are 2 key factors that are specific for PoD.
PoD usually starts (and stays) in one place. It tends to appear around the mouth and in the folds of skin around your nose, though it can sometimes appear close to your eyes and even near your genitals.
PoD bumps are distinct in size and colour. These bumps are often red in people with Fitzpatrick skin types I-IV and flesh-coloured in people with V-VI skin. Although at first glance they can be mistaken for small pimples, on closer inspection, you may notice that these bumps are more characteristic of tiny fluid filled blisters. The rash typically causes dry, flaky skin, and may also come with itching and even burning.
One of the most common causes of PoD is incorrect or overuse of topical steroids whether applied deliberately to facial skin or inadvertently. This includes nasal steroids, steroid inhalers, and steroid tablets.
Other common causes include:
- Fluoridated toothpaste
- Hormonal changes and/or oral contraceptives
- Cosmetic creams, make-ups and sunscreens
In those with sensitive skin, using too many different skincare products at once, or certain ingredients may trigger perioral dermatitis. Particularly noteworthy examples are retinoids and vitamin C. Whilst these ingredients can do great things for your skin, they are well known triggers for the dreaded PoD. If you have very sensitive skin, speak to your dermatologist about which ingredients are most appropriate for your needs before investing in quality skincare. Creams that are too occlusive are more likely to cause PoD.
Self care (what can I do?)
Firstly, try not to pick or squeeze your spots.
For ongoing management, it’s important to consider personal care products that are absent of irritants such as methylisothiazolinone (MI & MCI), and contain key anti-inflammatory, well tolerated ingredients. Some of our favourites which we highlight often are zinc, niacinamide and resveratrol. Gentle cleansers are a must if you are prone to PoD. We advise that you avoid exfoliants, foaming cleansers and toners. Gentle cream or milky cleansers will avoid flaring up your rash.
The good news is mild perioral dermatitis can be treated with non steroid anti-inflammatory agents such as tacrolimus or pimecrolimus cream or ointment. Moderate to severe cases of PoD will require oral therapy to get things under control. Anti-inflammatory oral antibiotics such as erythromycin and doxycycline often need to be used for 6-12 weeks (add in a probiotic).
Very recalcitrant cases may rarely require isotretinoin.
If your PoD is recurrent or persistent, see your dermatologist sooner rather than later.
We’re very happy to answer your questions on PoD, simply leave us a comment or send an email to firstname.lastname@example.org