I Thought I Just Had Acne, But It Was Actually a Less Common Skin Condition

About a year and a half ago, I spotted a small cluster of red bumps around my nostrils and chin. At first, I didn’t think much of them—I figured they were just zits. So imagine my surprise when my dermatologist told me that the inflamed spots stemmed from something I’d never heard of in my years as a health reporter and editor: perioral dermatitis, a condition that can cause bumps on your chin and around your mouth and nose. The over-the-counter acne creams I was slathering on my face apparently weren’t going to help me, either.

At the time I was 28, which put me squarely in the middle of the demographic for perioral dermatitis, a condition that most commonly strikes women between the ages of 15 and 45, peaking in their 20s and 30s. Children can develop the condition, too. And while precise data on its prevalence doesn’t seem to exist, at least one paper refers to it in general terms as “relatively common.” Through my own experience, as well as several interviews with experts, this is what else I was able to learn about dealing with it.

The symptoms of perioral dermatitis include flesh-colored or red bumps that circle your mouth and sometimes your nose, as in my case. The bumps can also show up around your eyes and even around your vagina or rectum, in which case the condition is called periorificial dermatitis. Sometimes the spots can look scaly and they might burn, says Julie E. Russak, a New York City-based dermatologist and assistant clinical professor at Mt. Sinai School of Medicine.

The most telling sign, says Iris Looi, a physician assistant at the Russak Dermatology Clinic in Manhattan, is itchiness and sudden onset—as in, it’s a new condition that you’re experiencing. Acne is not typically itchy, and usually appears over a long period of time, Looi adds. Since it can look a lot like acne, it takes a trained eye to determine what’s really going on, so you’ll want to consult a dermatologist if you think you have it. The good news? Perioral dermatitis doesn’t cause serious health problems, Looi says. The bad: As I learned, it can be very frustrating to deal with.

Perioral dermatitis is inflammatory and almost like an allergic type of reaction, Russak says. Why it occurs, however, isn’t completely understood yet. Sometimes people develop perioral dermatitis shortly after using topical steroid creams, which—ironically—are used to treat inflammatory skin conditions. In one recent study, roughly 9 percent of people who put steroid creams on their face for a month or longer developed the condition. Several case reports also suggest that nasal steroids, commonly used to treat allergies, might lead to perioral dermatitis, too—but the reasons why are unclear. (More on that in a moment.)

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Other triggers may include stress, food sensitivities to sugar and gluten, and even the fluoride in oral hygiene products. Your doctor should ask about your habits to pin down any lifestyle factors that could be causing or exacerbating your skin irritation, Looi says. “I often ask patients with perioral dermatitis if they’ve recently switched toothpastes or started a new mouthwash, because sometimes mouthwash containing fluorides can be the cause.”

While it can be helpful to stop using an offending product or cut out a food that isn’t working with your skin, every case is a little different. One series of case reports published back in the ‘80s, for instance, described how one woman developed perioral dermatitis from marjoram, another from bay leaves, and another from cinnamon. Their faces improved after they stopped eating the spices.

Perioral dermatitis is a highly individualized condition, so unfortunately there’s no one-size-fits-all treatment that works for everyone. Your doctor might prescribe one or more topical or oral medicines, including a topical immunomodulator such as pimecrolimus, a topical antibiotic such as sodium sulfacetamide or erythromycin, an oral antibiotic such as doxycycline, or a sulfur face wash. All of them help to reduce skin inflammation.

Pimecrolimus cream, which was originally developed as a treatment for eczema, might be particularly effective at quickly relieving symptoms of perioral dermatitis that stemmed from previous use of topical steroids, according to one study.

No matter what product you wind up treating your skin with, consider refreshing the rest of your skincare lineup, too. I used to be more adventurous with my skincare routine—always trying the latest exfoliant or serum or whatever I could get my hands on. When it came to perioral dermatitis, however, I found that simplicity worked best.

“For patients with PD, we advise a gentle skincare regimen: no harsh exfoliants or drying acids,” Looi says. “These can exacerbate the condition.” Instead, she recommends gentle washes such as Cetaphil or Cerave, and being careful about what you slather on next.

“Perioral dermatitis is almost like an allergic type of reaction, so think of products designed for sensitive skin—no heavy creams, no heavy lotions,” Russak says. “I highly recommend creams and lotions with niacinamide because it’s a powerful and natural anti-inflammatory agent.” (Niacinamide is a form of vitamin B3.) Russak also recommends avoiding retinol (vitamin A) and vitamin C in the affected area, which could further irritate your skin.

One of the most important aspects of dealing with perioral dermatitis treatment is practicing patience—and, for me, it was the hardest part. Perioral dermatitis can last for weeks, months, or in some cases years, and you might have to try several different treatments before you find one that works.

“Perioral dermatitis can take a long time to resolve due to the inflammatory process of the skin, which takes longer to normalize than run-of-the-mill eczema or acne,” Russak says.

Tor Shwayder, director of pediatric dermatology at Henry Ford Hospital in Detroit, usually asks patients to stick with a treatment for two to three months. If the bumps don’t clear up, he adjusts the regimen.

Perioral dermatitis was first described in the scientific literature nearly 50 years ago, but there are still some major knowledge gaps around the condition. In recent years, a few research groups have looked to elucidate the causes and find better ways to treat it. One theory is that bacteria may be involved: A Japanese study, for instance, found that most perioral dermatitis patients had rod-shaped bacteria lurking in their lesions. An antibiotic regimen helped to clear things up.

Another school of thought suggests that a parasite might be behind the condition: One Slovenian study found that people with perioral dermatitis were more likely to have Demodex follicularum mites in their skin than people in a control group, and the presence of these mites might have been a result of the patients’ exposure to topical steroids. Along the same lines, researchers gave adults with perioral dermatitis an anti-parasite cream, which helped to soothe their symptoms in one study. Finally, another group of researchers in Germany are continuing to study a far less costly, natural method of treatment involving the application of black tea compresses to soothe perioral dermatitis, but they haven’t published their results yet.

In other words, there’s still a lot we don’t know about perioral dermatitis, which is frustrating for those of us that struggle with this annoying condition. Dermatologists, however, do have several strategies that can help you get things under control. I’m one of the unlucky people stuck with a slow-to-resolve case of perioral dermatitis, but I’ve tamped it down considerably by washing my face every day with a prescription-only face wash containing sodium sulfacetamide and sulfur, and applying pimecrolimus when my skin flares. My struggles aren't over yet, but I've made progress—while learning a few lessons in patience along the way.

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