Ask The Expert: What is perioral dermatitis?

If you’ve ever noticed tiny red bumps around your mouth and nose area, it could be a skin condition called perioral dermatitis.

While it is not often talked about, the condition is more common than you think as there are many possible causes and triggers. In March this year, skincare founder and model Hailey Bieber opened up about her personal struggles with the inflammatory condition that is characterised by itchy red pustules around the mouth and eyes. The 27-year-old shared that new facial products, changes in the climate and certain SPF products can aggravate her condition, which is why she opts for gentle, anti-inflammatory formulas to calm her skin.

But how can you tell if a skin flare-up is actually perioral dermatitis? We spoke to skincare experts Dr Rachel Ho of La Clinic and Dr. Lee Hwee Chyen of Epi Dermatology & Laser Specialist Clinic to get the lowdown on all things perioral dermatitis – from symptoms to solutions.

Commonly mistaken for acne of rosacea

According to Dr Ho, perioral dermatitis is an inflammatory eruption of the skin around the mouth. It is typically characterised by small inflammatory papules and pustules or pink, scaly patches. This condition can also appear in the skin around orifices such as the eyes, nostrils, and the genitals, hence, it is also referred to as peri-orificial dermatitis.

Dr Lee echoes this, adding that the skin is usually dry, itchy and scaly with some patients experiencing tightness and stinging in the affected areas. “What sets it apart (from acne or rosacea) is a classical distribution affecting the nasolabial folds and perioral region, with a distinct zone of sparing around the vermillion border of the lips. Acne usually affects the oil prone areas of the face like the T-zone, or the chin and/or jawline. Rosacea often presents over the centrofacial area, including the nose,” she explains.

The exact cause is unknown

Like so many other skin issues, the exact cause is unknown. That said, the pros agree that it can be triggered by prolonged use of topical steroids on the face or even inhaled/intranasal steroid use.

Dr Ho adds that existing skin concerns like a predisposition to allergies and infections (caused by certain fungi and bacteria) as well as the use of “fluoridated toothpaste and certain skincare products (such as physical sunscreens particularly in children)” may exacerbate the condition.

“Other reported triggers include zinc deficiency, hormonal changes, yeast infections etc. Even physical factors like harsh UV exposure, heat and strong winds,” says Dr Lee.

Keep your routine simple

If you’re struggling with perioral dermatitis or think you have it, the experts suggest discontinuing cosmetics and steroid creams as well as potential irritants like retinoids/retinols, fragrances and preservatives.

“Your dermatologist will prescribe topical antibiotics and/or anti-inflammatory topicals in the form of steroid-sparing medications. These are all prescription based. Severe cases may require oral antibiotics,” says Dr Lee.

“Opt for gentle facial wash and skincare as much as possible. Products that contain azelaic acid may help with the symptoms,” Dr Ho adds

Get a prompt and early diagnosis

Patience is key. “Treatment may take several weeks to months,” according to Dr Lee. “It can also be tricky to diagnose at the start; it may get mistaken for acne, eczema or rosacea. Prompt and early diagnosis is therefore important so as to start an appropriate treatment plan as soon as possible,” she advises.

Dr Ho cautions that “if the rash is not improving despite trying the above mentioned steps, it’s time to see a doctor as medications may be required.”

Dr Rachel Ho is the Medical Director of La Clinic with over a decade of experience in dermatology.

Dr Lee Hwee Chyen is the medical director and consultant dermatologist at Epi Dermatology & Laser Specialist Clinic with a special interest in paediatric dermatology, women’s dermatology and procedural dermatology.