Perioral dermatitis is an acne-like rash around the nose and mouth and sometimes around the eyes. Although it often has little pimples scattered around the nose, mouth, chin and less frequently around the eyes, it can look more “rashy” with red, dry, scaly patches or both the pimples and dry patches. Although it is an easy diagnosis for dermatologists, it is often misdiagnosed by good doctors in other fields because it can look like so many other things such as acne, eczema, seborrheic dermatitis, etc. The problem is that some acne medicines such as retinoids, benzoyl peroxides, etc. can make this rash worse. And medicines to treat eczema or seborrheic dermatitis such as steroids, including OTC hydrocortisone, will seem to initially make the rash better, but eventually the rash flares because steroids are actually “fuel for the fire” when it comes to perioral dermatitis.
Perioral dermatitis almost always affects women and children but is rarely seen in men. We are not sure what causes this rash, but it may be products used on the face in some cases. Whatever the cause, the great news is that this rash is curable—which is not to say the rash will never come back…it can but usually years later if it does.
Treatment of perioral dermatitis is fairly straight forward but requires you to discontinue topical steroids if you are using them. The best treatment is oral antibiotics such as minocycline, doxycycline or tetracycline (TCN is difficult to get) but other antibiotics such as azithromycin are also effective. These oral antibiotics usually take care of the rash within a few weeks at most unless steroids have been used for a long time. Topical treatment with antibiotics such as topical erythromycin, clindamycin or metronidazole are also effective but work much more slowly.
So if you have persistent annoying acne or dry rashy skin around your eyes or mouth, consider the fact that you may have perioral dermatitis.