I Thought I Just Had Dry Skin, But It Was Actually Perioral Dermatitis

During a particularly stressful time, I had a flare-up of perioral dermatitis (PD), a scaly red rash, to the right of my mouth. It's something I had never even heard of, and definitely was not the run-of-the-mill dry skin that I assumed it to be when it first cropped up.

It turns out that perioral dermatitis is somewhat common both around the mouth and under the nose. After I posted about it on my Instagram Stories, multiple people messaged me to say that they, too, have experienced the skin condition. Unfortunately for me, each of them had pretty different advice for how to treat it. Some told me to exfoliate with alpha hydroxy acids (AHAs), others said to use only the most gentle skin-care products. Many said a topical antibiotic cream was all that would work.

For something so common, why is there so much confusion? I talked to experts to figure out how to treat the rash around my mouth called perioral dermatitis, which could be dry and itchy and is often mistaken for eczema around the mouth and nose.

• Joshua Zeichner, MD, is a board-certified dermatologist in New York City.
• Morgan Rabach, MD, is a board-certified dermatologist in New York City.
• Kate Somerville is an aesthetician and founder of Kate Somerville Skin Care.
• Renée Rouleau is an aesthetician and founder of Renée Rouleau Skin Care.

• What is perioral dermatitis?
• What causes perioral dermatitis?
• How should I treat perioral dermatitis at home?
• When is it time to get a prescription to treat perioral dermatitis?

What is periorial dermatitis, exactly? Well, for starters, it is a facial rash that usually shows up around the mouth, Corey L. Hartman, a board-certified dermatologist in Birmingham, Alabama, has told Allure. It can pop up in other areas as well — around the nose, chin, even the outer parts of the eyelids, and cheeks — and usually presents as red and bumpy, so it may be mistaken for other skin conditions, like acne or rosacea. Unlike acne, it can be itchy, although that's not always the case, so if you have red bumps around your mouth it's best to see a dermatologist who can help diagnose.

The rash is not contagious, and it's not totally clear what causes it — but it may be that something is irritating the skin (moisturizer, or even toothpaste) or that you're allergic to an ingredient in your skin care. Or it it may be a reaction to longtime use of a corticosteroid medication, says Dr. Hartman. Sometimes, the bumps can be puss filled, adds Joshua Zeichner, MD, a board-certified dermatologist in New York City. I

"Despite being common, we still do not understand why perioral dermatitis develops," Zeichner explains. According to him, there are many theories, including the use of topical cortisone creams, fluorinated toothpaste, heavy skin-care products, asthma inhalers, and — yep — stress.

My red pumps aren't fluid-filled, but I did have a small rash under my nose before it popped up by my mouth. Sometimes the area even burns and feels tight and uncomfortable. According to Morgan Rabach, a board-certified dermatologist in New York City, this is also common. "The rash may be accompanied by itching or burning, or it may just appear with no sensation at all," Rabach tells me. "[It often] appears really for no reason around the mouth, nose, or eyes and comes and goes."

Dermatologists agree that we don't really know what causes perioral dermatitis, but we can treat it and hopefully prevent it from coming back. "Any environmental change can lead to perioral dermatitis," says Rabach, like "using different skin-care products, for example, with new ingredients that may cause inflammation in your skin." She notes these ingredients can include fragrance, dyes, or preservatives, especially if you're allergic, as well as actives such as retinol and acids.

I am not one of those people, though, who tries out all kinds of new skin care; I've been sticking to my normal skin-care routine. My perioral dermatitis seems to have come from nowhere.

Kate Somerville, aesthetician and founder of Kate Somerville Skin Care, says she sees this a lot in her Los Angeles clinic. "Very often, we see clients with perioral dermatitis," she says. "We see this with a variety of clients with different skin tones and ages." She treats the condition with a soothing facial to decrease inflammation and redness, as well as LED light therapy. But Somerville agrees that it's really about prevention and decreasing flare-ups. She recommends skipping exfoliation when perioral dermatitis starts, using tepid water while cleansing the skin with a gentle cleanser (Allure editors like Vanicream Gentle Facial Cleanser and StriVectin Comforting Cream Cleanser), and avoiding product regimens that contain fragrance and dyes.

Renée Rouleau, aesthetician and founder of Renée Rouleau Skin Care, gives me similar advice. Rouleau has only seen skin-care changes and prescription medication help diminish perioral dermatitis. "I have not found any other lifestyle changes work," she says. "It's basically to remove any potential topical irritants, such as products with active ingredients." She recommends "really basic" products, such as a gentle, sulfate-free cleanser, a simple moisturizer, and a sunscreen (we like Dr. Jart+ Cicapair Tiger Grass Calming Gel Cream and La Roche-Posay Toleriane Double Repair Face Moisturizer SPF 30).

Dermatologists agree. Rabach likes to do an allergy patch test in her office to see if she can isolate what could be causing it. She adds, "you need a prescription when the rash isn't going away and keeps coming back and you don't know why."

All this considered, less is absolutely more when it comes to perioral dermatitis. I put down all my acids and vitamin C serums and retinoids and switched to a gentle, fragrance-free routine. The rash around my mouth calmed down in terms of being dry and itchy, but it was still there. I needed a bit more intervention with a prescription, it seemed.

If changing up your skin-care routine and avoiding irritations and allergens don't work (like in my case), a topical antibiotic might do the trick. Zeichner likes prescriptions such as Metrogel and Soolantra if over-the-counter treatment options don't take care of the problem in two to four weeks. Oral antibiotics are also sometimes given for their anti-inflammatory properties, says Rabach. These medications work at decreasing redness and swelling and are used for rosacea as well.

In the meantime, I started checking the ingredients in my skin care more. I've noticed products with fragrance, especially products that aren't rinsed off, such as night creams, make my perioral dermatitis worse. I'm also trying to take better care of myself in general. That means eating real meals (popcorn doesn't count), getting some fresh air, and going to bed earlier.

We don't always realize how stress affects our body until there's an issue that needs to be fixed. I ended up getting a Metrogel prescription and watched my skin start to heal within a week. Hopefully, with a little care and some medical intervention, my skin might even flourish after all.

More on skin and skin-care products:

• The Most Commonly Misdiagnosed Skin Conditions, According to Dermatologists
• The 24 Best Face Masks of All Time, According to Allure Editors
• The 21 Best Bar Soaps to Lather Up With During Your Next Shower

Now, watch Jay Park's 10-minute skincare and hair routine:

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