Perioral Dermatitis - Symptoms, Causes and Treatment for Mouth Rash

Perioral dermatitis is a dry, sometimes itchy rash that forms around the outside of a person's mouth. Sometimes the rash will spread to the nose and eyes and in rare cases spread all over the body.

There is no known cause, but it is suspected to be related to the use of topical steroid creams on the face. It can be treated with a variety of topical medications and oral antibiotics but it is sometimes resistant to treatment. If perioral dermatitis is successfully treated, it may recur several times over the course of the patient’s life.

Signs and Symptoms

The most obvious sign of perioral dermatitis are small bumps around the mouth. These bumps, called papules, will usually appear in clusters and may be difficult to spot unless you look closely. For people with light skin, these bumps are bright red. For people with darker skin, they are the same color as the rest of their skin. These bumps may leak pus if they are picked at or scratched.

Granulomatous perioral dermatitis is a variant of this condition. People with the granulomatous variant develop yellowish bumps instead of red ones. This variant is more common in children, especially those of African descent. However, people of all ages and racial backgrounds can develop it.

Other symptoms of both standard and granulomatous perioral dermatitis include:

• Dry, flaky skin

• Itchy skin

• A burning sensation around the rash, especially in the creases between the nose and mouth

Perioral dermatitis is often mistaken for acne because the sores look similar to pimples. However, perioral dermatitis sores are not located around blocked hair follicles like acne sores. Perioral dermatitis also doesn't usually cross the vermillion border--the thin flesh-colored border around the darker parts of your lips--while acne might.

Causes

Women between the ages of 25 and 45 are more likely to get perioral dermatitis than the general population. Researchers believe this is probably because this group is the most likely to use facial and topical steroid creams.

Aside from face cream use, some leading theories include:

• Use of inhaled steroids such as nasal sprays.

• Lifestyle factors such as gum chewing, using fluoridated toothpaste, and dental fillings.

• Hormonal changes, whether natural or induced using oral contraception.

• Problems with the epidermal barrier or top layer of your skin.

• Problems with your immune system.

• Irritation from cosmetics or sunscreen.

• Abnormal microflora on the skin.

• Demodex mites, the tiny bug-like creatures that live on the skin.

• Candida albicans, a type of yeast.

• Follicular fusiform, a type of bacteria that is often present in high numbers around the mouth.

Scientists are investigating these theories, including the possibility that the condition might have multiple triggers.

Is It Contagious?

No. Perioral dermatitis is a type of skin inflammation, not a contagious disease. You cannot spread perioral dermatitis to another person or catch it from someone who has it. You also cannot catch it from someone who has had it in the past.

Treatment

Treating this condition can be tricky. The inflammation will not clear up until you have removed whatever is irritating your skin.

If you have been applying over-the-counter hydrocortisone cream on your face, stop immediately. This does not apply to topical prescriptions from your doctor. Always ask your physician if it’s OK to stop using it. Continue to use it until your doctor advises otherwise.

The rash may become worse after you stop applying the cream, but this is temporary. Continuing to apply the cream may cause the rash to become worse each time you use it.

If your rash doesn't clear up after stopping the steroid cream, or if you were never using a cream, you may need to see a dermatologist for additional treatment.

During your first appointment, your dermatologist will confirm if your rash is perioral dermatitis. They will ask about your medical history and any topical creams you have used in the recent past. Depending on your answers, they may narrow their list of potential causes and settle on an effective treatment.

Treating perioral dermatitis at this stage often involves trial and error. Most dermatologists will begin by prescribing topical treatments such as ointments, gels, and creams. These treatments may contain any of the following active ingredients:

• Erythromycin

• Clindamycin

• Adapalene

• Pimecrolimus

• Tacrolimus

• Azelaic acid

Your dermatologist may also prescribe oral antibiotics or other medications to help reduce the inflammation around your mouth, including:

• Tetracycline

• Doxycycline

• Minocycline

• Erythromycin

• Isotretinoin

These medications are usually prescribed alongside topical treatments. Your dermatologist may have you try a few different combinations until you find one that works.

How Long Will It Last?

Perioral dermatitis is slow to improve, even after treatment. While you should start to see some improvement almost immediately, it may take weeks or even a few months for the rash to clear completely.

This condition may reoccur, so even when it does clear up, it might not be gone forever. If it does return, the same treatment that helped the first time will likely work again. Keep treating it each time and avoid picking at any of the sores or it may cause permanent scarring.

Prevention

The most effective way to prevent perioral dermatitis is to limit the use of steroid creams on your face. Do not use any over-the-counter steroid creams. If you are prescribed a steroid cream, ask for the lowest possible strength and use it only for the time directed by your doctor.

It also helps to wash your face regularly using a gentle debt-free soap or soap substitute. This keeps the skin clean and hydrated and washes away any residue from cosmetics or lotions that might irritate the skin.

In most cases, these precautions should be enough to keep you from developing perioral dermatitis. However, neither of these methods are guaranteed to work. Researchers are still gathering more information on what causes this condition to help people treat and prevent it.