Itchy face? Spots or tender bumps around the mouth? Or perhaps near the eyes or nostrils? You could have perioral dermatitis. Perioral dermatitis (POD), also known as perioral dermatitis, appears as small, itchy bumps around the mouth, nose and the sides of the eyes. The bumps are usually small (1 to 2 mm) and clustered. The most common areas affected include the chin and upper lip.
How common is this?
Perioral dermatitis is a worldwide problem and can affect anyone no matter their background. However, young women ages of 16 and 45 are most commonly affected. But, even children and older adults may have perioral dermatitis.
What causes perioral dermatitis?
Scientists and doctors are not exactly sure what causes perioral dermatitis. It may be associated with skin irritation or eczema. Some scientists point to immune system dysfunction as the cause. Perioral dermatitis may also be related to chronic use of topical steroids. Sometimes, patients with rosacea are given topical steroids. Overuse of these medications can actually cause perioral dermatitis. Even though topical steroids may initially help in the treatment of perioral dermatitis, most patients see a more severe rebound effect once the topical steroid is stopped.
What other clues are there besides red bumps around the mouth, nose and eyes?
- The vermillion border – also known as the area between the upper lip and the adjacent normal skin — is usually not involved. The eyelids are typically involved as well.
- There aren’t other features of acne. There are no whiteheads or blackheads. Perioral dermatitis also doesn’t affect the back or chest. But, it’s important to note that acne and perioral dermatitis can coexist together.
- The surrounding skin may be dry and flaky.
What else could it be?
There are various other skin disorders that may be similar to perioral dermatitis and it is important to get a diagnosis from a doctor. The other potentially similar disorders include:
- Seborrheic dermatitis
- Allergic or irritant contact dermatitis
- Impetigo, a superficial skin infection
You definitely should ask your doctor about all of these possibilities.
What do I do about an Itchy Face?
- The first line in the treatment of perioral dermatitis involves stopping any usage of topical steroids and avoiding skin care products or cosmetics that may be irritating the surrounding skin. Think of this as avoiding anything that may potentially be irritating the face or exacerbating the bumps. This is known as zero therapy and has scientific evidence backing up its efficacy.
- In certain scenarios, in consultation with your dermatologist, flares can be treated with higher potency topical steroids for short periods of time. But, follow your doctor’s instructions closely.
- For mild to moderate disease, agents such as topical pimecrolimus or tacrolimus (a non-steroidal cream), topical erythromycin (an antibiotic), or topical metronidazole (another antibiotic) may be used. You can work with your doctor to decide what is best for you.
- For more severe disease, oral drugs may be used. This typically involves oral tetracyclines (a type of antibiotic) such as doxycycline or minocycline. Ask your doctor about whether you need these medications.
- On a day-to-day basis, wash the face with warm water alone. When the lesions have cleared, you can transition to a very mild facial cleanser. We have a few recommendations of cleansers here.
- When applying sunscreen to the face, choose a liquid or gel sunscreen. These tend to be less irritating than cream based sunscreen.
How long will these bumps be here?
Perioral dermatitis usually resolve with a few months by stopping topical steroids and skincare products. However, the disease course can vary. Scientific studies have shown that the prescription treatments (both topical and oral) can really help. The bottom line is to concentrate on zero therapy and to work closely with your doctor to find the best treatment for you.