Perioral dermatitis is a relatively common skin condition, but it can appear without warning, linger even with treatment, and leave people feeling frustrated. According to Dr. Channing Hood of U.S. Dermatology Partners Golden, CO, “One of the most frustrating things about perioral dermatitis is that it’s complicated to treat due to the extended, non-linear healing process. Understanding how perioral dermatitis flareups heal is the first step to manage this chronic skin condition. A dermatologist can help you tackle this complicated healing process.” In this blog, Dr. Hood answers the question what is perioral dermatitis, outlines underlying causes of this condition, and walks through the three key phases of healing: regression, relocation, and oscillation.
What is Perioral Dermatitis?
Perioral dermatitis is a skin condition that causes irritation and rash on the face, especially around the mouth (the perioral region). It also frequently develops on the nose and around the eyes. It causes clusters of red bumps or red thickened skin that can itch or cause discomfort. According to Dr. Hood, “The symptoms and appearance of perioral dermatitis leads to it frequently being confused for acne, eczema, rosacea, or contact dermatitis. However, perioral dermatitis requires unique treatment. For this reason, it’s important to get an official diagnosis and develop a treatment plan with your dermatologist.”
Possible Causes and Contributing Factors
Unfortunately, there is not a single cause of perioral dermatitis. However, there are a variety of factors that increase risk for triggering flareups in this skin condition, including:
- Use of topical corticosteroids – this is one of the most well-documented triggers of perioral dermatitis flareups. Even over-the-counter hydrocortisone creams can trigger or worsen perioral dermatitis flares. Discontinuing steroid use is the first step in perioral dermatitis treatment.
- Brushing with fluoridated toothpaste – while fluoride is beneficial for teeth, it’s not great for skin. Some people experience symptom improvement after switching to a non-fluoridated toothpaste.
- Applying specific cosmetic products – regular use of makeup and skincare products that are heavy and pore clogging or those that have irritating ingredients that contribute to symptom flareups.
- Fluctuating hormones –changes in hormone levels, particularly in women, increases risk for perioral dermatitis flareups.
- Exposure to environmental irritants and aggressors – humidity, heat, and wind exposure may trigger symptoms.
- Use of nasal sprays or inhalers – these products, particularly those containing corticosteroids, can trigger perioral dermatitis symptoms.
Healing Stages of Perioral Dermatitis
When it comes to healing following perioral dermatitis flareups, Dr. Hood says, “One of the most frustrating things about this skin condition is that healing isn’t usually a quick or linear process. Understanding the healing stages of perioral dermatitis ensures realistic expectations and prevents concern when setbacks arise.” Below, Dr. Hood outlines the three stages of perioral dermatitis and what to expect during each.
1. Regression: Signs of Initial Improvement
During this initial healing stage, inflammation associated with perioral dermatitis begins to subside. Redness and bumps may start to clear up, and skin may not feel as irritated. During the regression stage of healing, patients may experience dryness and peeling. Throughout the regression stage, it’s important to use only gentle skincare products and avoid harsh exfoliants.
2. Relocation: When Symptoms Shift
The second healing phase, relocation, can be the most frustrating for patients. Just when they think skin is clearing up, symptoms start to shift into new areas adjacent to the original flareup. Many patients worry this means their symptoms are spreading, but it’s usually a sign that skin is responding positively to treatment, which causes inflammation deeper in skin’s layers to reach the surface.
3. Oscillation: Ups and Downs
Finally, patients enter the oscillation phase of healing. During this last phase, skin may oscillate between looking completely healed to showing signs of a flareup. This stage can last weeks, months, or longer. It occurs because the skin is slowly healing its microbiome and flushing toxins and irritants from the deep layers of skin. These symptoms are most noticeable when skin is exposed to triggers like stress, hormonal fluctuations, and changes in weather. It’s essential to keep treatment consistent during this phase even when it feels hopeless.
Treatment and Management
Very mild cases of perioral dermatitis may resolve without dermatologist treatment, but most people require dermatologic support to achieve true clearance. Below, we outline the top dermatologist tips for perioral dermatitis treatment.
The Most Important First Step: Stop Using Steroids
If you are using topical steroids or corticosteroid nasal sprays or inhalers, cease treatment as soon as possible. You may want to consult with your physician before discontinuing prescription medications. In some cases, corticosteroids are prescribed to treat perioral dermatitis after a misdiagnosis. While these medications suppress symptoms temporarily, they can cause symptoms to return more aggressively once steroid use is discontinued.
Topical and Oral Medications
To address the symptoms of perioral dermatitisdermatologists may prescribe:
- Topical antibiotics such as metronidazole, erythromycin, or clindamycin.
- Topical anti-inflammatory medications like tacrolimus or pimecrolimus.
- Oral antibiotics such as doxycycline, minocycline, or tetracycline, especially for those with moderate to severe cases that aren’t responsive to topical treatments.
Treatment Duration:
Most people begin to see symptoms improving within the first few weeks of treatment, but the relocation and oscillation phases last six to twelve weeks on average, but some patients require longer treatment to achieve full skin clearance.
When to See a Dermatologist
Because perioral dermatitis mimics other skin conditions like acne, rosacea, contact dermatitis, or seborrheic dermatitis, receiving an accurate diagnosis from a professional dermatologist is the foundation of effective treatment. It’s important to seek dermatologic treatment for perioral dermatologist if:
- Symptoms persist despite discontinuing steroid use and switching to a gentle, minimalist skincare routine.
- Rash or bumps spread beyond the initial area.
- You experience significant discomfort, burning, or itching.
- Recurring flareups aren’t responsive to over-the-counter treatment.
Stay Consistent & Seek Support
According to Dr. Hood, “Healing from perioral dermatitis is not always linear, and the process requires patience, consistency, and understanding of the perioral dermatitis healing timeline. It’s normal to feel frustrated during flareups or confused when symptoms shift, but these are a natural part of skin’s repair process.”
Schedule a Dermatology Consultation to Learn More
At U.S. Dermatology Partners, our skilled dermatologists provide diagnosis and treatment for even the most complex skin conditions, including perioral dermatitis. Ready to take the next step? Use our quick online request form to schedule a consultation with one of our board-certified dermatologists and take control of your skin health.
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