Until I was diagnosed with it last year, I'd never heard of perioral dermatitis. I'd developed a red, slightly bumpy rash around my nose and mouth, and no matter what I used to try and soothe it – from hyaluronic acid serums to LED face masks – the rash never improved. Thinking I'd developed an allergy or sensitivity to a certain ingredient, I stripped my skincare routine back to the very basics – a cleanser and moisturiser specifically for sensitive skin. It didn't seem to help. I also thought it might be caused by hayfever; an allergic flare-up or a reaction to frequently blowing my nose. But then hayfever season passed, and the rash was still there.
After a rather unhelpful visit to my GP, I decided it was time to visit a dermatologist. I booked an appointment with Dr Eirini Merika, consultant dermatologist and head of dermatology at the Montrose Clinic, who immediately identified the rash as perioral dermatitis, a condition characterised by a red rash and papules around the mouth area which celebrities including Hailey Bieber, Joey King and Amanda Seyfried have been vocal about suffering from.
Dr Merika prescribed me a week's course of zineryt cream – a topical antibiotic solution commonly used to treat acne – followed by Elidel cream, a steroid alternative often used to treat eczema, every night for a week, then every other night, then twice a week before discontinuing use and switching to a moisturiser for sensitive skin.
Within a few weeks, I saw a marked improvement in my dermatitis and while I'm still prone to mild redness around my nose, the telltale bumps and rashes of perioral dermatitis have completely subsided.
Here, Dr Merika explains what causes perioral dermatitis, why it so often gets misdiagnosed, and how to prevent it happening…
What is perioral dermatitis and what are the causes?
Perioral dermatitis is a chronic inflammatory skin eruption around the mouth area. The exact cause is not fully understood. It most likely arises from a disturbance to the skin barrier allowing increased penetration of exogenous agents and enhanced water loss, both of which contribute to skin inflammation.
Skin barrier disturbance may be a result of overuse of active ingredients such as retinol or exfoliating agents, over-hydrating or occlusive moisturisers, sunscreen use, heavy make-up use, irritant contact factors such as toothpaste, hormonal factors (pregnancy, menstruation, contraceptive pill use), environmental (heat/wind/UV radiation) and skin infections.
In an effort to soothe the skin, there is a tendency to use more topical products that end up penetrating the already disturbed skin barrier more, leading to further irritation.
Stress can also be a contributing factor. While the condition is often linked to topical products, hormonal changes, or overuse of steroids, emotional and psychological stress can exacerbate inflammation and trigger flare-ups. Managing stress is an important, and often overlooked, part of supporting skin health.
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How can you tell the difference between perioral dermatitis and other common skin complaints?
There are many skin conditions that can look similar to perioral dermatitis, including rosacea, acne, seborrheic dermatitis, contact dermatitis, even skin infections and rarer autoimmune skin conditions like sarcoid. Misdiagnosis can lead to wrong treatment administration and deterioration (such as the use of topical steroids which may temporarily improve the rash, but ultimately contribute to its development).
Instead of the dry, flaky skin that you characteristically get with other types of dermatitis, classic perioral dermatitis presents with clusters of painless, small skin-coloured or red papules (bumps) around the cheeks, nasolabial folds or mouth (but sparing the upper lip).
That's why it's important to book with an experienced dermatologist who should be able to distinguish between different conditions.
How can you prevent perioral dermatitis?
- Avoid overuse of cosmetic products, particularly active ingredients such as retinoids.
- Avoid harsh exfoliation.
- Avoid perfumed moisturisers.
- Avoid picking/squeezing spots.
- Avoid regular topical steroid use. If using a steroid cream elsewhere on the body, make sure you wash your hands before touching your face.
- Seek help at the first signs of skin irritation developing.
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How is perioral dermatitis treated?
Although it's usually a benign, self-limiting condition, it can run a chronic relapsing course if not identified early and rectified. Which is why it is important to seek help early from an experienced dermatologist. If perioral dermatitis is suspected, all facial cosmetic products should be stopped, but a non-soap cleanser and bland moisturiser without any additives may be used. Then other treatments may be proposed, including topical anti-inflammatory therapies or topical antibiotics, but even oral antibiotics may be required.
Although it can sometimes take a few weeks to clear, perioral dermatitis usually has an excellent response to treatment.
What are some of the best moisturisers for sensitive skin?
Dr Merika suggested this La Roche-Posay moisturiser, beloved by beauty editors and derms, to soothe my skin and help calm and prevent dermatitis flare-ups. It helps repair and protect the skin barrier while providing prebiotic hydrating care. The result of rigorous dermatological testing, it's suitable to use on even the most sensitive skin – even babies'!
This may be on the expensive side, but it's one of the best lightweight, gentle daytime moisturisers I've ever used. I apply in the morning after cleansing and my skin is soft, hydrated and soothed all day, while any redness is visibly reduced. It's also the perfect base for makeup, even in the heat.
CeraVe AM Facial Moisturising Lotion SPF50
- Consistency: Lightweight cream.
- Skin type: Normal to dry skin.
- Key ingredients: Ceramides, vitamin E, niacinamide.
Why we love it: Developed by dermatologists with sensitive skin in mind, this day cream will address all of your skin needs. The affordable face moisturiser contains three essential ceramides that help restore your natural skin barrier. Beyond that, the stripped-back formula keeps things simple to avoid irritating sensitive skin. It has over 70% of 5 star ratings on Amazon for a reason.
Tester: Shaunelle Harrydass-Clark, Glamour's Intern.
Tester's skin type: sensitive.
Testing time: 4 weeks.
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Developed by dermatologists with sensitive skin in mind, this affordable moisturiser contains three essential ceramides that help restore your natural skin barrier. Beyond that, the stripped-back formula keeps things simple to avoid irritating sensitive skin. It's a firm favourite in the Glamour office.
