Tuesday, 18 November 2014

Cheat Sheet - Perioral Dermatitis or 'those red annoying spots that won't go away'

So. A really quick and simple one:
  • You've had spots/redness/flakiness/looks like eczema/you thought it was acne but it isn't - for ages in one place around your mouth or nose (or eyes - poor you). They're not particularly big, they don't seem to want to LEAVE and sometimes they seem to multiply.
  • You have clusters of spots/redness/flaking around your nose that laugh at you and say 'nice try!' when you apply spot treatments
  • You have clusters of spots/redness/flaking around your mouth that laugh at you and say 'nice try!' when you apply spot treatments
  • Sometimes they sting 
  • Sometimes they burn
  • Sometimes they flake over and literally peel off
  • Sometimes they go, disappear altogether and give you a sense of satisfaction - then POP BACK UP AS IF LIKE MAGIC
  • The thought of using exfoliating acid on the area makes you feel a tad faint
Source

Sound familiar? You may have perioral dermatitis (or periorifical dermatitis if it's your eyes). No panic or worry required, it's very common and easily fixed. If though, you ignore it, it can spread. And even when you get rid of it - it will probably come back, so best to arm yourself in preparation.

While it occurs predominantly in women aged 20-45, giving it a possible hormonal factor, men and children can also be affected. The causes are multiple and the triggers can be a combination of differing things:

  • reaction to some cosmetic products
  • reaction to steroid creams (often referred to as steroid rosacea)
  • strong winds/UV light (think joggers and chapped faces)
  • hormonal contraception
  • dribbling in your sleep (that's attractive)
  • fluoride in toothpaste
  • SLS in toothpaste/cleansers

The parts of the face affected are near areas that are warm, dark and wet - the perfect combination for bacterial growth.

It's easily treated. If you know it is a recurring problem visit your doctor, you will either be prescribed a topical cream or oral antibiotics if it's really severe. I'm writing about it now as it always flares up on me in winter. I just got rid of a round of PD on my mouth. I used Bactroban for a few weeks as it wasn't severe enough for antibiotics and I prefer to keep those for something major....

It varies from a tiny patch of redness to severe flaking and bleeding so I'm not using pictures as it's so different in everyone. The Google link for pictures of mild PD is here - if you had severe PD you would probably have already been to the doctors.








70 comments:

  1. Hi Caroline, Can you buy Bactroban over the counter? Clare x

    ReplyDelete
    Replies
    1. I don't think so. You need a pX.

      Delete
    2. Dear Caroline, regarding the triggers, do you think is could be something bacterial growth in the skin? I have treated my overgrowth yeast, I eat healthy, no sugars, no fluoride , not too many cosmetics, and still my chin is always red, sometimes super dry, it peels off skin after applying sunscreen , or a tiny bit of foundation , I use now Exuviance products, a dermato cosmetolog recommended it, is better, but not entirely healed , after 2 months of using these product, still very hard to hide the redness. What would you suggest ? 

      Delete
  2. This comment has been removed by a blog administrator.

    ReplyDelete
  3. Am having an ahaa moment (feel like Alan partridge). I’ve been stalking your site ever since a red/flaky/sore patch appeared on my chine and to one side of my mouth. As I’d never had anything like this before I just assumed it was a dry patch and have been slapping thick moisturise on…. But it’s not really shifted. It’s a bit spotty so sort of as described. One question though….How would I tell the difference between PD and mild rosacea?
    Oh and I LOVE the blog (so the red patch has at least bought somthing good into my life!)

    ReplyDelete
    Replies
    1. Rosacea would more likely be across your cheeks than on your chin. There's no 'fixed' definition, but its more likely PD if you haven't been using strong steroid creams.

      Delete
  4. Here is another thing to add to my list of things to discuss with the dermatologist when I go for my referral appointment next week. Scalp eczema, nail issues and your description of PD sums me right up!

    ReplyDelete
  5. Any skincare regimen recommendations for PD?

    ReplyDelete
    Replies
    1. No. See your doc! Avoid too many products on the area - I literally use the antibac cream on the area and everything else everywhere else.

      Delete
  6. Gosh Caroline, I too had an aha moment reading this and looking at the pics!

    At the moment it's pretty much under control thanks to your recs of double-cleansing, facial oils, exfoliating toner and facial massage have all helped massively. I'm using much kinder cleansers too.

    I have been thinking about getting the Decleor Purifying Balm too. Definitely asking doc for Bactroban next time I have a flare up.

    Thank you again, you genius skin goddess, Caroline! xxx

    ReplyDelete
  7. THANK GOD you post this - i've had PD for the past 2 years and been to the derm. He put me on some antibiotics and a topical gel for 6 months, then i stopped, and it came back! As of yesterday it got so worse (also the weather's changing cold) it was pure. despair. and. desperation.

    I've changed my toothpaste, shower and shampoo, facial cleanser, toned down on cosmetic use (can't go without, but toned down majorly), avoided steroids. The derm raised a choice to me if I'd consider taking Retin-A. I am reluctant, if it's the last resort out there I might consider it.

    Just want to see if anyone has similar experience / how they cured their PD!

    ReplyDelete
    Replies
    1. Mine is getting on my nerves. I've resorted to zinc supplements for the winter and using the bactroban religiously. It's working at the mo.

      Delete
  8. I battled this over the summer and would like to let your readers know about my reaction: I was prescribed a low-level antibiotic which worked great and because it was such a low dose, I was told would be without side affects. A month later my chest and back were COVERED in red bumps, some of which end up having white heads, but not normal whiteheads and this was NOT acne. It eventually went away only to come back worse and started spreading and appearing on my face. The doctor and I finally figured out that the antibiotic was killing off bacteria that keeps the yeast in our skin in check, and this was essentially a yeast infection of my skin. I was prescribed a topical cream for that and stopped taking the antibiotics and it eventually went away, but the whole thing lasted ages, I was essentially wearing turtlenecks and hiding all summer. PLEASE try the topical (Phinacea in the US, need an RX) before going for the antibiotic, it could save you a lot of anguish.

    ReplyDelete
    Replies
    1. Yes I would always agree go topical first.

      Delete
    2. Hope you don't mind me asking, so is yours a yeast infection of skin instead of PD? if so I may need to talk with the derm again on this. I took antibiotics and had no such side-effects, it cleared up mostly during the past 6 months I'm taking it, and then eventually it came back.

      Delete
    3. No, mine is PD, the yeast infection was an added side effect from the antibiotics. They did work very well on the PD but I noticed that the PD came back as soon as I stopped taking them (I took two rounds, the yeast infection thing showed up halfway through the second) and I won't try again, so I guess I'll have to apply the topical from time to time. Although my dermatologist said it's something that you will battle once and then not get again, I've learned from my experience and others' (and what Caroline wrote above) that that is not the case. Keep a tube of topical around for flare ups?

      Delete
    4. I am not a medical doctor, but a microbiologist, so based on my own experience and some of the scientific literature I read, I concluded it can be caused by either yeast (like thrush) , bacteria, or both. The key is to know that it is your normal skin "flora" going a bit mad due to changes in the normal skin structure ( hormones, the elements, irritation by cosmetics, stress, etc). Oral antibiotics do work and are recommended in medical protocols, but I rather be patient and use a topical one, than getting something that risks altering my whole body's microbial balance. Fluconazole in Canesten cream is a good bet as it has both anti-candida and mild anti-bacterial effect, but it takes a while to have a significant long lasting effect (10 weeks in my experience).

      Delete
  9. Periocular for me (under my eyes) :( It's miserable. My doctor prescribed Desonide this summer - it helped but it has flared up again and I just can't figure out what's causing it (I've started a spreadsheet). Does acid toner help or hurt? This week, I've cut back to LRP cleansing milk, Ren Omega 3, & Ren Clear Calm Global Protection. Also started taking fish oil.

    ReplyDelete
    Replies
    1. I'm supplementing with zinc, and using the basics. I still use the acids, just in moderation.

      Delete
    2. I'll give it a try. Thank you so much for replying, Caroline, and good luck with yours too. - Kate

      Delete
  10. Thanks Caroline! Do you use the cream or ointment? Do you go through your whole routine as normal, applying everything on the red spots? And, between what stages do you apply the Bactroban? Thank you! Xx

    ReplyDelete
    Replies
    1. Bactroban after acid toning. Then everything else as normal.

      Delete
  11. It used to be called "Flight Attendants Disease" in Germany, because it was believed they were prone to it due to air condition and overuse of cosmetic products, but that was changed because to many people mistook it for a STD by that name.
    Love your cheat sheets, as always.

    http://www.lindalibraloca.blogspot.com

    ReplyDelete
  12. For some reason I have yet to meet a GP who'll prescribe an ointment - allllways with the oral antibiotics. When they'll even accept that, yes, really, I know what it is, and I'd very much appreciate them not trying to treat it with steroids. Good to have a product name to bring next time it comes back. I've been on three courses already in the last two years, moving to the UK and starting uni and being suddenly homeless in London several times over. Stress + cold will do it!

    ReplyDelete
    Replies
    1. Stress def makes it worse for me! And lack of sleep. :(

      Delete
  13. Thank you, thank you and thousand times thank you! Now, when the PD is gone, can I use exfoliating toners over the area? Retinol? What about moisturizers, is it true that I need to stay away from the really rich, greasy ones?

    Malin

    ReplyDelete
    Replies
    1. Yes they can aggravate. Retinols should be cool though.

      Delete
  14. Thank you!!!!!! Mouth kisses! I think this is the cause of the weird breakouts around my mouth and nose!

    ReplyDelete
  15. I just got diagnosed with this - had it for a year and didn't know what it was. I got prescribed antibiotics but was allergic to them so was given Protopic. What do you think of this cream Caroline? (I'm now using a natural toothpaste as I think regular Colgate was the problem) x

    ReplyDelete
  16. This comment has been removed by the author.

    ReplyDelete
  17. Thank you so much for this post Caroline. I was diagnosed with it from a steroid cream, I was prescribed a cream but it literally burnt my face off. I have it under control at the mo and I've pinpointed a few things that irritate it like spf in anything, essential oils and anything that mattifies my skin but hey ho. Caroline thank you so much, my skin has been so good since I've been following your advice. No more cystic acne for me xx

    ReplyDelete
  18. I have had 2 bouts of this - thankfully not for a while. Very frustrating that it took a few GP visits (who had attempted prescribing steroid creams) and self-diagnosis to finally get an antibiotic treatment that worked. Good to know others out there have experienced this. Embarrassingly I am a massive drooler and think that may have triggered mine!

    ReplyDelete
  19. For 2 months ive been using finacea and acticlate. Its all over my jawline , forehead and chin. Idk what to do

    ReplyDelete
  20. this may sound so stupid but I think I get this in the corners of my mouth from dribbling in my sleep because I'm disgusting... But I also get really watery and teary eyes and the corners of my eyes tend to get dry and red too, could this be the same kind of thing happening?

    ReplyDelete
    Replies
    1. No, not disgusting....only human, and more common than you think to have this type of issue. Have you consider putting on a thick balmy barrier cream in the corners of mouth before you go to the sleep ( something like waitrose baby bottoms butter, Shea butter, burts bee baby's barrier cream, etc) to sort of "waterproof" your skin, so your saliva is less damaging?

      Delete
  21. Thank you Caroline for all you information and time taken to offer help and advice with this PD. Wonder if it is hormonal? I am 50 and have some menopause symptoms. Also i have couple of areas only tiny whete skin flaked off and it is bit red underneath. Should i moisturise there or leave alone? Good luck to all of us dealing with this x

    ReplyDelete
  22. Omg how have I missed this?? As soon as my skin goes through another meltdown you post this! Bless you Caroline! I'm off to make a doctors appointment!

    ReplyDelete
  23. I had PD the entire spring to summer and it was very hard to get rid off. Came from too much stress... went away with the holidays, getting pregnant (I'm skin wise on the good side of pregnancy, hooray) and throwing everything that contained SLS in the bin. Apart from that, I was helpless, as everyone said "leave it alone", even the doctors and that, as you said, just made it spread. Oh and I consumed sh*tloads of anti-inflammatory foods such as curcuma, stinging nettle, dandelion tea... and switched to raw foods (was summer anyway, so not a biggie) - I guess all of that kinda helped. Haven't had it since, but it stayed for MONTHS. Especially around the nose. If you hadn't posted about it, I actually successfully repressed it haha x

    ReplyDelete
  24. Thank you so much for sharing this! This is exactly what my skin is going through at the moment and I had no idea what was causing it. Thank goodness for Caroline Hirons!

    http://www.holliemaem.blogspot.com

    ReplyDelete
  25. Hi All, I have had this for years and have used oral and topical anti-biotics for it, until I found the best results yet with, Tea Tree!
    Either tea tree oil diluted with water and wiped on the area twice a day or the tea tree cream you can get in Boots. Much better for your skin and cheaper than anything else. Also fluoride toothpaste helps alot.

    ReplyDelete
  26. A million thanks Caroline for touching on this topic and your advise. I suffer from this and it took me months of trial and error, diaries, inspection of INCI lists until I got it: a combination of peri menopausal hormones, long haul flights and teeth grinding resulted in a yeast infection around my mouth , which I think got super infected with bacteria. I treated with topical antibiotic cream for 4 weeks and canes ten for 10. Very religiously ! I have mostly conquered it, but now and then it rears it's ugly face again. I get back to canesten for 3 days and it disappears. I also rely on HCC with balm or oils, followed by a few drops of rose hip oil as serum and LRP Nutritic cream. Again, I am religious about this every night . I also stay away from Fluoride in toothpaste and SLS In anything; and stay loyal to certain foundations, lipsticks and other cosmetics that cause no issue after 7 days of continuos use. Sorry for the long message, but I want to share in case it helps at least one person out there.

    ReplyDelete
  27. Hi everyone,

    After reading Caroline's cheat sheet a couple of weeks ago, I realised I was suffering from something that sounds exactly like this around my mouth. Little spots that were a little sore and wouldn't clear up along with some flaky patches. I'm convinced it was caused after I left a face mask on overnight which I was trying for the first time, because I woke up with them the following day and they literally wouldn't go away. Anyway, after reading Caroline's recent posts about Lush, I remembered that my brother, who suffers terribly from eczema on his face, has been using Lush's Aqua Marina cleanser for literally the last ten years as that is the only thing that keeps his face calm and clear (along with Trilogy face cream), so I thought I would get some and give it a try for these "spots as it's only about £6 and I thought may as well give it a go. Within 2 days of using it (as a second cleanse in the PM after removing makeup, and AM cleanse) the "spots and flakiness" were clearing up and within a week they were gone. I had had them for over two months so I am convinced this is what has worked. Obviously everyone's skin is different so it may not work for others, especially if people have it really severely, but I would really recommend giving it a go if you can afford to purchase a pot. If it doesn't get rid of it, it is still a lovely cleanser so wouldn't be a waste of money.

    Anyway, really hope this post helps someone and thank you to Caroline for taking the time to write such helpful cheat sheets : )

    xx

    Hope this helps someone.
    Hannah xx

    ReplyDelete
    Replies
    1. Doh, didn't mean to write "Hope this helps someone" and blow kisses twice! Lol!

      Delete
  28. After struggling for months. I tried antibiotics and changed all of my products. I was getting my nails done and the girl beside me said try psoriasin. It worked within a couple of days. It causes dryness but I just put some polysporin in it and within days it was completely gone. I bought it at Walmart it comes in a bingo dobber type bottle.

    ReplyDelete
  29. I think I skimmed this as thought it wasn't relevant to me, but do think my 7yo could have a mild case. I thought it was eczema at first (which he is prone to) but it has been hanging around for too long. Not itchy & doesn't bother him but doesn't look pleasant & like you've said, I'm worried about it spreading.

    ReplyDelete
  30. Hi Caroline,

    You wrote that you'd been dealing with perioral dermatitis "on your mouth." I am currently dealing with tiny, eczema-like bumps on my lips, as well as a mild outbreak of PD below my mouth (which antibiotic cream appears to be stamping out). Was wondering whether you've encountered/experienced a similar manifestation of PD, or whether you know if it's common for PD to spread onto the lips. My derm wasn't helpful on this point, and nor is the Internet at the moment! Would greatly appreciate any insight you could offer.

    ReplyDelete
  31. My perioral dermatitis was cured in 3 weeks. Follow these steps:

    1. STOP PUTTING ANYTHING ON YOUR FACE. No makeup, no face wash, no lip balm, no moisturiser, no essential oils, NOTHING. Especially avoid products such as Lucas' Pawpaw Ointment that has a hidden ingredient, Balsam of Peru (or myroxylon), and can trigger perioral dermatitis.
    2. You seriously have to follow Step 1. Although it may be tempting and it might feel soothing to put something on the rash, but trust me, your pores can heal themselves. They need to breathe.
    For about the first two days, it will seem like things are getting worse. Your dermatitis may get really red in your skin's attempt to release all the toxins. It will start flaking up, and this is a sign that it's healing. DO NOT SCRATCH/EXFOLIATE IT. Just leave it, and rinse only with water.
    3. In three-or-so days your body will have detoxified its skin, and you will now see improvements with each day that goes by. My perioral dermatitis was cured in 3 weeks. Avoid touching it with your hands.
    4. After the perioral dermatitis has subsided, try to stay as natural as possible with your skincare regime. Water is the best cleanser.

    I can guarantee you, this is the most natural and effective treatment.

    ReplyDelete
    Replies
    1. Bullshit :) <3 I had this more or less severely all year round from age 10-22, and I didn't put anything what-so-ever on my skin for at least the first 4 years.

      Delete
  32. Bactroban is not sold in my country:( I have a very mild case. A pink dry pacth below/beside my mouth.

    I am going to see if it passes, but if it spreads, I see no other option than antibiotics... which is a shame, but thats the only thing the doctors recommend:(

    ReplyDelete
    Replies
    1. Fucidin comes in both and ointment and a cream and can be used instead of Bactroban as they perform similarly under medical testing for a range of skin infections. That's my go-to choice for when I get flare-up on either my face or body. I just asked my doctor for both the cream AND the ointment version which I apply to the most appropriate area. You can check out the abstract from the clinical trials here: http://www.ncbi.nlm.nih.gov/pubmed/2502567

      Another potential alternative you could suggest to your doctor is Neosporin,

      Delete
  33. Bactroban is not sold in my country:( I have a very mild case. A pink dry pacth below/beside my mouth.

    I am going to see if it passes, but if it spreads, I see no other option than antibiotics... which is a shame, but thats the only thing the doctors recommend:(

    ReplyDelete
    Replies
    1. Bactroban is a topical antibiotic (mupirocin) .

      Delete
  34. Okay I suffer from perioral dermatitis and the last year it has been absolutels under control. What helped me:
    1. Don´t put on any kind of cream on when you are currently having a bad phase! It will just make it worse.
    2. Don´t use liquid foundations to cover it up. Try very drying powder foundations or, if you are able to, go barefaced.
    3. Be patient- By following the two steps on the top I started to notice that I would get less pimples every day until after like two weeks I wouldn´t get any new pimples and I started to wait for the healing process.
    4. I would always take my powder off with just hot water and a towel on my chin (when I wore powder) and it was the best option for me.
    5. When everything is healed you can slowly start wearing makeup again. Also if I wear any moisturizer on my chin I highly recommend the Weleda Calendula one.
    6. You start getting pimples again? Repeat the steps above!

    Okay I am by no mean an expert but these steps helped me a lot and at the really bad phases of my perioral dermatitis I would have tried anything! I would mix a dark foundation with theatre paint to cover it up( don´t do it your face will break out badly) and be ashamed to go in public. I hope the best for everyone and good luck!

    ReplyDelete
  35. Hi Caroline,

    Just discovering your website after your 'In the Bathroom' with Sali Hughes. So glad I did - after much googling I now think that my boyfriend has perioral dermatitis. I ordered him some samples of AHA/BHA exfoliators from the Paula's Choice website as I thought they would help (I wasn't sure what it was at this point). Are they ok to use on the area, do you think? What about retinol? Thanks so much.

    ReplyDelete
  36. Peri• oral• dermatitis literally means rash around the mouth. The name doesn't indicate a cause because there isn't a known cause. I find it hilarious that we all go to our doctor and say, "hey, I have this rash around my mouth" and they essentially repeat back to us precisely what we just told them but in medical jargon and call it a day.

    ReplyDelete
    Replies
    1. I know! And if they haven't heard of it before, and you use the latin, there's a tendency that they'll assume the worst - Idk what that is exactly, maybe that some other doctor tried to mollify a persistent patient with a bit of pointless latin? Anyway, the result tends to be them trying to fob you off with a steroid, in my experience.

      Delete
  37. Hi Caroline,
    I've had a rash around my mouth for over two months now after being to doctors who thought it was eczema/acne.. and it wasn't until I went to a skin specialist that she said it looks like perioral dermatitis! I'm going to the doctors ASAP to get some treatment. Is bactroban what you'd definitely recommend over other creams?
    Phoebe x

    ReplyDelete
  38. This comment has been removed by the author.

    ReplyDelete
  39. I think I have this around my nostrils, nothing around chin or mouth, just nose area. Itchy, flakey, sore sometimes small spots.
    Been given metrogel, not working. Should I try caneston ?

    ReplyDelete
  40. I think I have this around my nostrils ? Started about 10mths age, thought it was just where I was wiping nose due to Hayfever. Red, sore nostrils, small spots, flaky skin, itchy sometimes. Been given metrogel by GP she thought it was acne rosesca. Considering trying caneston ?

    ReplyDelete
  41. I've noticed that once I got my perioral dermatitis under control I could tolerate more weather extremes. But prior to that, body temp extremes made it much worse. I put up a little post about it here http://peri-oralautoimmune.weebly.com/temperature-extremes.html

    ReplyDelete
  42. Hello to all. Had first and only flare up last fall at age 52, after taking antibiotics for a dental issue. Started small and got big. After 2 months of trying various suggestions, I heard about the zinc oxide crEames, aka diaper rash cream. Used it and, being fair skinned, 2 low dose low time trips to tanning bed per week. It would clear up and come back, but weakened each time. Took about a month, but it has been completely gone since November 2015. Have normal smooth skin back. Thank God! Wishing you all luck, healing, peace of mind, and confidence.

    ReplyDelete
  43. Hi everyone!
    My PD came on with pregnancy, but was misdiagnosed as acne, doc gave me steroid cream :( So when I spotted using this, it flared up really, really badly, like a red beard of hideous flaky itchy rash. Nice!
    Pregnancy means no antibiotics, so dermatologist have me Skin open cream (some kind of acid stuff) and this seems to be nailing it, slowly. Needless to say that I've looked like an aids patient for my whole pregnancy,(no makeup allowed at all) really good for self esteem!
    Now, I'm going back to dermatologist to see if it's actually gone.. Still a residual redness.. Hoping it won't scar :(
    Meggie

    ReplyDelete
  44. I had PD about 5 or 6 years ago and was given oral anti-biotics which cleared it right up. I've not had it since until about 2 weeks ago when I got what I thought was a hormonal breakout, my hormones are changing & I've had more spots in the last couple of years than I did as a teenager. However with the usual 'spot' clearing regime not working I looked again at pictures of PD and it appears that it is back, oh yay!! My first thought this time was to come here as I knew you had a cheat sheet on it. I was pleased to see that this morning's routine was the right move, I cleansed and acid toned but didn't put anything else on the affected area, both sides of my mouth and chin and come Monday I'll call my GP and ask for a topical anti to try this time. I'm not sure if I can use Bactroban as I'm on a slew of meds for Rheumatoid disease but will see what she says. Many thanks again Caroline for being my first port of call as far as my skin is concerned.

    ReplyDelete
  45. Hello,

    Do you ladies have any kind of ingredie ts list (link on web site) in makeup and cosmetic that we should avoid when dealing with PD? I KNOW we should not be using anything, but I have to use makeup in my work so I am looking for less harm in big harm :) if you know what I mean.
    This would help a lot!!!!
    THANK YOU IN ADVANCE

    ReplyDelete
  46. https://osmiaorganics.com/blogs/blog/13768653-perioral-dermatitis-eczema-meet-acne
    I found this really helpful!

    ReplyDelete
  47. Just been diagnosed with both peri oral, and peri ocular dermatitis and a touch of rosacea just to be sure! Ferm has told me to take antibiotics for 3 days a month for 3 months, as well as topical gel and cream! SHe recommended Cetaphil or LRP to cleanse and moisturise. MAkeup was to be either LRP or Clinique ( the rosacea range). I have LRP so that's fine. Let's see how it goes! At least I know I'm not going mad! I suspect it s made worse by Liquid Gold! I don't know if I'll now have to throw out my entire collects of lotions and potions! Aaaaagh!

    ReplyDelete

Follow this blog with bloglovin

Follow on Bloglovin
Related Posts with Thumbnails