Perioral Dermatitis Treatment

What is perioral dermatitis?

Perioral dermatitis (POD) is a chronic inflammatory skin condition that typically affects the skin around the mouth, nose, and eyes. It appears as small red bumps, sometimes with associated dryness, burning, or tightness. While it commonly occurs around a single orifice (most often the mouth — perioral), it may also involve the eyes (periocular), nose (perinasal), or, more rarely, the genital area.

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Who gets perioral dermatitis?

Perioral dermatitis is most commonly seen in women aged 20–45, but it can also occur in children — typically between the ages of 7 months and 13 years. While more frequently observed in lighter-skinned individuals, it can affect all skin types.

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What causes perioral dermatitis?

The exact cause of POD remains unknown, but several contributing factors are well recognised:

• Use of corticosteroids, especially on the face, via creams, nasal sprays, or inhalers

• Heavy or occlusive skincare products, including petroleum-based emollients and some sunscreens

• Cosmetics and personal care products, especially those with irritants or allergens

• Epidermal barrier dysfunction, which may be related to over-cleansing, harsh products, or nutritional deficiencies (e.g., zinc)

• Hormonal influences, including fluctuations during pregnancy or with oral contraceptives

• Environmental triggers, such as heat, UV exposure, and wind

• Microbial involvement, with organisms like Demodex, Candida, and certain bacteria isolated from lesions — though their role is still debated

• Atopic background — people with sensitive or allergy-prone skin may be more vulnerable

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What does perioral dermatitis look and feel like?

Perioral dermatitis typically presents as:

• Clusters of small, red, pimple-like bumps (papules or pustules)

• Affected areas include the skin around the mouth, nose, and sometimes eyes or forehead

• The skin between the lips and the surrounding rash (vermilion border) is often spared

• The surrounding skin may be dry, flaky, or scaly

• Patients often report burning, stinging, or tightness; itch is common, pain is rare

• Lesions are generally less than 2mm but may coalesce in more extensive cases

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In children, a variant called granulomatous periorificial dermatitis may occur, often following the use of topical steroids, and presents with yellowish bumps.

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How is perioral dermatitis diagnosed?

Diagnosis is made clinically by a healthcare professional through a careful history and skin examination. No tests are usually required. In persistent or unusual cases, patch testing may be considered to rule out contact allergy.

 

What is the treatment for perioral dermatitis?

Perioral dermatitis is benign and self-limiting, but treatment is often needed for symptom control, cosmetic concerns, and to break the steroid-rebound cycle. Treatment involves a stepwise approach:

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1. General measures: "Zero therapy"

• Discontinue all topical corticosteroids — even weak over-the-counter products

• Stop using all cosmetics, face creams, scrubs, and heavy moisturisers

• Wash the face with warm water only until the rash settles

• Use a simple, non-occlusive moisturiser if needed for dryness

• Avoid physical sunscreens during active flares; consider gel or liquid formats if needed

• If on inhaled or nasal steroids for other conditions, continue only if medically necessary and rinse the face afterwards

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2. Topical treatments (used cautiously due to skin sensitivity)

• Anti-inflammatory topical agents from the antibiotic or immunomodulator classes

• These may be rotated every 6–8 weeks if the rash does not respond

• Additional options include agents from the keratolytic, anti-acne, or anti-inflammatory classes, although evidence is limited

• Some topical immunomodulators have also been trialled but should be used with care, as they can sometimes exacerbate the condition

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3. Oral (systemic) treatments

• Oral medications from the tetracycline or macrolide antibiotic classes are often first-line

• Treatment typically lasts 6–8 weeks, with the possibility of a second course if needed

• These medications work through their anti-inflammatory, not antimicrobial, action

• Sub-antimicrobial dosing may be effective in some patients

• Children and pregnant individuals are prescribed agents considered safe for their age or pregnancy status

 

What’s the outlook?

Perioral dermatitis generally resolves with treatment, and most patients see improvement within a few weeks. Avoiding future triggers — especially facial steroid creams and irritating skincare — helps prevent recurrences. With a tailored treatment plan and supportive skincare guidance, long-term control is achievable.

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For resistant, recurrent, or cosmetically severe cases, referral to a dermatologist is recommended.

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At Domain Dermatology, we understand how frustrating and persistent periorificial dermatitis can be. Our specialist-led team offers expert diagnosis, personalised treatment plans, and long-term support to help restore your skin’s health and confidence. Book a telehealth consultation today and get the care you deserve — wherever you are in Australia.

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