by Caspian Whitlock - 10 Comments

What Is Perioral Dermatitis?

Perioral dermatitis is a common skin condition that causes small red bumps, sometimes with pus, around the mouth, often spreading to the area near the nose and eyes. It doesn’t affect the red part of the lips directly, which helps doctors tell it apart from other rashes like acne or eczema. It’s most common in women between 16 and 45, with about 9 out of 10 cases happening in women. Many people mistake it for acne at first, but there are no blackheads or whiteheads - just a ring of irritated skin that can burn or itch.

Unlike acne, this isn’t caused by clogged pores. It’s an inflammatory reaction, often triggered by things you put on your face. About 78% of people with this condition say it affects how they feel about their appearance, and many avoid social situations because of it. The good news? It’s not contagious. And with the right care, it can clear up - but only if you stop the triggers.

Top Triggers You Need to Stop Right Now

The biggest trigger? Topical steroids. Whether it’s hydrocortisone cream from a pharmacy or a prescription ointment, using these on your face for more than two weeks sets off a cycle. At first, the redness fades - that’s why people keep using it. But then it comes back worse. Eighty-five percent of cases are linked to steroid use, and 92% of people who use them long-term see rebound flare-ups.

Other common triggers include:

  • Heavy moisturizers - anything with petroleum jelly, dimethicone, or beeswax above 15% can clog the skin barrier and cause inflammation. This affects nearly half of all cases.
  • Fluoridated toothpaste - sodium fluoride at levels of 1,000-1,500 ppm triggers reactions in 37% of people. Brushing right before bed or swallowing small amounts can worsen the rash.
  • Makeup foundations - especially those with isopropyl myristate or heavy oils. Sixty-eight percent of cosmetic-related flare-ups come from foundation.
  • Physical sunscreens - zinc oxide or titanium dioxide above 10% can irritate sensitive skin. Even if labeled “gentle,” thick mineral sunscreens often make it worse.
  • Hormonal changes - 55% of women notice flare-ups before their period. Oral birth control can also play a role in 28% of cases.
  • Environmental factors - wind and sun exposure worsen symptoms in 63% and 41% of cases respectively. UV rays don’t cause it, but they make it harder to heal.

Some people also report issues with chewing gum, dental fillings, or even gluten. While these aren’t universal triggers, if you’ve tried everything else and still have flare-ups, it’s worth exploring.

Why Gentle Skin Care Isn’t Just a Trend - It’s Medicine

When you have perioral dermatitis, “gentle” doesn’t mean mild fragrance or natural ingredients. It means zero irritants. Most people wash their face twice a day - that’s the problem. Washing too often strips your skin’s natural oils and makes inflammation worse. Eighty-eight percent of patients see improvement just by cutting back to once daily.

Here’s what you need to change:

Cleansing: Less Is More

Stop using foaming cleansers, scrubs, or anything with salicylic acid, glycolic acid, or retinoids. These are too harsh. Instead, use a non-foaming, pH-balanced cleanser (between 5.5 and 6.5 pH). Cetaphil Gentle Skin Cleanser is one of the most recommended because it doesn’t strip or irritate. Use it only once a day - preferably at night. Rinse with lukewarm water. Pat dry, don’t rub.

Mothurizing: Lightweight Only

Forget thick creams. You need something that hydrates without sealing in irritation. Look for moisturizers with:

  • Ceramides between 0.5% and 2%
  • Hyaluronic acid below 1%
  • No petrolatum, lanolin, or silicones

Vanicream Moisturizing Cream is a top choice because it’s free of dyes, fragrance, and common allergens. Apply a thin layer only when your skin feels tight - not every morning and night.

Sun Protection: Skip the Zinc Creams

Don’t skip sunscreen - UV exposure makes healing slower. But skip thick mineral sunscreens with zinc or titanium dioxide above 5%. Instead, use a lightweight gel or fluid sunscreen with less than 5% mineral filters. EltaMD UV Clear Broad-Spectrum SPF 46 (with 4.7% zinc oxide) is widely used and tolerated by patients. If you’re still reacting, try a wide-brimmed hat. Physical barriers work better than chemical ones for this condition.

Makeup: Minimal and Clean

If you must wear makeup, choose fragrance-free, non-comedogenic products. Avoid anything labeled “oil-free” - that doesn’t mean it won’t clog pores. Look for titanium dioxide below 3% and zero isopropyl myristate. Tinted moisturizers with SPF are better than full-coverage foundations. And always wash it off before bed.

What About Toothpaste?

This is one of the most overlooked triggers. If you’ve been using regular fluoride toothpaste, switch to a non-fluoridated version. Look for ones with sodium lauryl sulfate below 0.1%. Brands like Tom’s of Maine Fluoride-Free or Jason Natural Toothpaste (SLS-free) have helped 62% of patients within 4 to 6 weeks. Don’t just switch - rinse your mouth well after brushing and avoid letting toothpaste sit near your lips overnight.

A hand applying light moisturizer to irritated skin, with discarded creams in the background, in Studio Ghibli style.

Medical Treatments That Actually Work

While gentle skin care is essential, many people need medical help too. Here’s what dermatologists recommend based on clinical data:

  • Metronidazole 0.75% gel - applied twice daily for 8 weeks clears up 70% of cases. It’s anti-inflammatory, not antibacterial, so it doesn’t kill bacteria - it calms the skin.
  • Pimecrolimus 1% cream - a non-steroid option that works in 65% of cases with fewer side effects than antibiotics. Good for long-term use.
  • Doxycycline 40mg modified-release - for moderate to severe cases. This low-dose version has only 12% side effects (like stomach upset), compared to 45% with the older 100mg dose. It takes 12 weeks to fully clear, but relapse is lower if you finish the course.

Treatment usually lasts 6 to 12 weeks. Stopping early increases your chance of recurrence to 40%. Even if your skin looks better at week 6, keep going.

What Doesn’t Work - And Why

Many people try home remedies like apple cider vinegar, tea tree oil, or coconut oil. These can make things worse. Coconut oil is occlusive - it traps irritants. Tea tree oil is a known skin sensitizer. Vinegar changes your skin’s pH, which invites more inflammation.

Also, don’t use “natural” or “organic” products unless they’re specifically formulated for sensitive skin. Just because something is plant-based doesn’t mean it’s safe. Many botanical extracts are potent allergens.

And no - you can’t just “wait it out.” Without stopping triggers, perioral dermatitis often returns. In fact, 40-60% of people who don’t identify their triggers see flare-ups again within months.

Real Patient Success Stories

On Reddit’s r/SkincareAddiction, thousands of people share their journeys. The most common successful routine? Three products:

  1. Cetaphil Gentle Skin Cleanser
  2. Vanicream Moisturizing Cream
  3. EltaMD UV Clear SPF 46

They all stopped steroids, makeup, and fluoride toothpaste. The first two weeks were brutal - their skin got redder and more irritated. That’s the steroid withdrawal phase. Seventy-eight percent called it “the worst part.” But after three weeks, most saw improvement. By week six, 63% had clear skin.

One woman shared that she’d been using hydrocortisone for two years, thinking it was eczema. Once she stopped, her skin broke out worse - but within 10 weeks, it cleared completely. She now uses only those three products and wears a hat in the sun.

How Long Until You See Results?

Here’s what to expect:

  • Week 1-2: Worsening. This is normal if you stopped steroids. Your skin is rebelling.
  • Week 3-4: Redness starts to fade. Itching decreases.
  • Week 5-8: Bumps begin to disappear. Skin feels less tight.
  • Week 9-12: Clear or mostly clear skin. This is when you can slowly reintroduce products - one at a time.

Don’t rush. If you add a new moisturizer or sunscreen too soon, you risk triggering another flare-up. Wait at least 4 weeks between introducing anything new.

A woman walking through a forest at dawn, face clear, wearing a hat, with healing butterflies around her, in Studio Ghibli style.

Can Diet Help?

Some people swear by gluten-free diets. In Dr. Dropin’s clinic, 43% of patients with gluten sensitivity saw improvement. But Cleveland Clinic says only 12% of unselected patients benefit. So it’s not a universal fix - but if you have other symptoms like bloating, fatigue, or brain fog, testing for gluten sensitivity might be worth it.

There’s no strong evidence for dairy, sugar, or spicy foods causing perioral dermatitis. But if you notice a pattern - like flare-ups after eating chocolate or wine - track it. Individual triggers vary.

Preventing Recurrence

Once your skin clears, the work isn’t over. Forty percent of people get it back because they go back to old habits. To stay clear:

  • Never use steroid creams on your face - even for a day.
  • Keep your skincare routine simple: one cleanser, one moisturizer, one sunscreen.
  • Read labels. Avoid anything with fragrance, alcohol, or occlusive ingredients.
  • Use non-fluoridated toothpaste long-term.
  • Wear a hat in strong sun or wind.
  • See a dermatologist if it comes back - don’t self-treat with steroids again.

Patients who follow these steps reduce their recurrence rate from 60% down to 25%.

Frequently Asked Questions

Can perioral dermatitis go away on its own?

It can, but only if you stop all triggers - especially steroids and heavy skincare products. Most people need active management. Without changes, it usually returns or gets worse over time.

Is perioral dermatitis the same as acne?

No. Acne has blackheads and whiteheads caused by clogged pores. Perioral dermatitis has small red bumps or pustules around the mouth, no comedones, and is triggered by skin irritation, not oil or bacteria.

Can men get perioral dermatitis?

Yes, but it’s rare - only about 1 in 10 cases. Men who develop it often have used topical steroids for beard irritation or used heavy facial moisturizers. The same triggers and treatments apply.

How do I know if my moisturizer is too heavy?

Check the ingredients. If it contains petrolatum, dimethicone, lanolin, or beeswax near the top of the list, it’s too occlusive. Look for water-based, lightweight gels or lotions with ceramides under 2% and no fragrance.

Can I use retinoids or acids after I heal?

Not for at least 6 months after clearing. Retinoids, AHAs, and BHAs are too irritating for skin that’s had perioral dermatitis. Even after healing, your skin may remain sensitive. Reintroduce slowly, if at all.

Why does my skin burn when I use water?

Your skin barrier is damaged. Hot water, hard water, or frequent washing worsens this. Use lukewarm water, limit washing to once a day, and apply moisturizer immediately after patting dry. Over time, the barrier repairs itself.

Next Steps

If you’re dealing with perioral dermatitis, start here:

  1. Stop all steroid creams immediately - even if your skin gets worse at first.
  2. Switch to non-fluoridated toothpaste.
  3. Use only Cetaphil or similar gentle cleanser once a day.
  4. Apply Vanicream or another ceramide-based moisturizer sparingly.
  5. Use a light sunscreen with under 5% zinc oxide - or wear a hat.
  6. Stop all makeup for at least 4 weeks.
  7. See a dermatologist if you don’t see improvement in 3 weeks.

This isn’t about perfection. It’s about consistency. Your skin has been through a lot. Give it the quiet, simple care it needs to heal - and it will.