Perioral dermatitis
Specialist assessment and treatment for perioral dermatitis
At Midland Skin we offer perioral dermatitis treatment for patients in Birmingham, Solihull, Coventry, Wolverhampton, Worcester and the Midlands.
Quick Facts about perioral dermatitis
Best for
Persistent facial rash
Appointment
Initial dermatology assessment
Treatment
Skincare + prescription
Symptoms
Red, spotty, sensitive skin
Provider
Consultant dermatologist
Price
See below
What is perioral dermatitis?
Perioral dermatitis is a facial rash that causes clusters of small red bumps or pustules, together with redness, dryness or flaking. The skin may also feel sensitive, tight, itchy or burning.
It most commonly affects the area around the mouth. The same type of rash can occur around the nose or eyes, when it may also be described as periorificial dermatitis.
Perioral dermatitis is not contagious and usually does not cause scarring. However, it can persist or repeatedly flare and can be difficult to distinguish from other common facial skin conditions such as rosacea, ezema and acne.
When should I see a dermatologist for perioral dermatitis?
If a facial rash is persistent, keeps returning or has not responded to the things you have already tried, a dermatology assessment can help establish what you are actually dealing with and how best to treat it.
A specialist assessment can be particularly useful when:
- you are not sure whether the rash is perioral dermatitis, acne, rosacea, eczema or another facial skin condition
- the rash is persistent, recurrent or spreading
- it involves the skin around the nose or eyes as well as the mouth
- the skin is increasingly sensitive, uncomfortable or difficult to manage
Scarlett Greenwood
Why getting the diagnosis right matters
Perioral dermatitis can look very similar to several other common facial skin conditions. Specialist assessment helps establish the most likely diagnosis before deciding what treatment is appropriate.
Acne causes comedones whereas perioral dermatitis does not. The spots in acne also tend to be larger and deeper. There may be cysts and scars. Spots are usually on the jawline, cheeks and forehead. Perioral dermatitis does not cause scars (in the same way that acne can ), but it can cause prolonged redness.
Rosacea tends to affect the central face and may cause spots, persistent redness, flushing and visible small blood vessels. Rosacea and perioral dermatitis can occasionally occur together.
Eczema or contact dermatitis tends to produce more generalised areas of inflamed, itchy or flaky skin rather than the characteristic clusters of small bumps seen with perioral dermatitis. Another name for eczema is dermatitis. However perioral dermatitis is not typical eczema even though it shares a similar name. Eczema does not cause pimples. However, perioral dermatitis can occur in someone who is treating their eczema with steroid creams as a side effect.
Treatment pathway
Initial dermatology assessment
You meet with a dermatologist who assesses the rash and reviews your symptoms, skincare routine, previous treatments and relevant medications
Care plan
A treatment plan is discussed with you. This may include skincare changes and prescription treatment. Tests are only required where the diagnosis or another possible cause needs further investigation.
Review consultation
A review consultation is required to assess your response to treatment and decide whether treatment should be continued, changed or stopped. Your dermatologist will also discuss ongoing management where appropriate.
What causes perioral dermatitis?
The causes of perioral dermatitis are not entirely clear. Problems with the skin barrier function appear to be a major issue in perioral dermatitis.
The skin barrier is the top most layer of cells on the skin. These are bound together by lipids (fats) such as ceramides. They are a bit like bricks and mortar. They form a barrier that keeps the outside out, and the inside in. The barrier stops irritants from disturbing the skin and also prevents dehydration and water loss.
It is very possible that when the skin barrier is not functioning properly, common things in the environment such as sun light, environmental pollution, skin care products such as cleansers, toners, serums, exfoliants, sunblocks and other products may start causing an immunological reaction that leads to perioral dermatitis.
One of the strongest recognised associations is the use of topical corticosteroid creams on the face. Steroid creams can temporarily suppress the rash, but repeated use may perpetuate it and the rash can flare when the steroid is stopped.
Triggers that may cause or flare perioral dermatitis are:
- Excessive skin cleaning and washing.
- Using harsh products, especially acids, on the skin
- Applying very thick layers of make up, sunblock and moisturisers
- Skin care products that have a lot of alcohol based preservatives
- Immunological reactions to bacteria and yeasts on the skin
- Sun light
- Steroid creams (even steroid eye drops, steroid nasal spray and steroid inhalers may cause perioral dermatitis)
- Stress
- Perioral dermatitis can flare at various stages of the menstrual cycle from hormonal changes
- Wearing masks. Some cases of maskne may actually be perioral dermatitis.
How is perioral dermatitis treated at Midland Skin?
Fortunately there are very effective treatments for perioral dermatitis. These are the simple steps to follow:
Simplify your skin care regime and use just a cleanser and moisturiser.
The first step is to improve the skin barrier function. Use a very gentle pH neutral skin cleanser and a non-occlusive moisturiser. A light moisturiser several times a day is better than a heavy moisturiser applied once. This will allow the skin to breathe, protect it from water loss, but not clog pores. You will need to stop exfoliating products, acids, peels, scrubs, masks, astringents and any thing else that can disrupt the skin barrier.
Use prescription medications under the guidance of a Dermatologist.
Sometimes you will need prescription treatments to help control perioral dermatitis. Common prescription medications your doctor may recommend for you to control perioral dermatitis include the following listed below:
- Azaleic acid
- Metronidazole
- Clindamycin
- Erythromycin
- Pimecrolimus
- Ivermectin
For very severe cases you may also need oral medications including:
- Oral antibiotics
- Isotretinoin
Minimise steroid creams
As steroids may trigger perioral dermatitis, you will need to review ways in which you can minimise the strength of steroid products used or better still come off them all together with your Dermatologist.
Can perioral dermatitis come back?
Some people have a single episode that settles with treatment, and does not return. Others, however, experience recurrent flares.
Recurrence does not necessarily mean that previous treatment failed. A further episode may follow renewed exposure to contributing products or steroids, or may simply reflect the variable course of the condition.
If the rash returns, treatment can often be used again. Making sure your skin care keeps your skin barrier healthy, and avoiding any triggering skin care products, will help control perioral dermatitis flares.
Your dermatology appointments: FAQs
Who will assess me?
You meet with a dermatologist who assesses the rash and reviews your symptoms, skincare routine, previous treatments and relevant medications
Will I receive a prescription at my first appointment?
A treatment plan is discussed with you. This may include skincare changes and prescription treatment.
Will I need any tests?
Tests are only required where the diagnosis or another possible cause needs further investigation.
If the appearance is unusual or the diagnosis remains uncertain, investigations such as a skin swab, scraping, patch testing or occasionally a biopsy may be considered.
What information is useful at my initial assessment?
Perioral dermatitis is usually diagnosed by taking a careful history and examining the skin. Your dermatologist will ask about:
- when and where the rash started
- symptoms such as burning, itching or sensitivity
- skincare and cosmetic products you use
- treatments you have already tried
- relevant eye drops, nasal sprays, inhalers or other medication
Why is a review consultation required?
A review consultation is required to assess your response to treatment and decide whether treatment should be continued, changed or stopped. Your dermatologist will also discuss ongoing management where appropriate.
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Fees
Perioral dermatitis Show pricing
Book ConsultationInitial dermatology assessment
Review consultation
Scarlett Greenwood
References used for this article
- Gray NA, Tod B, Rohwer A, Fincham L, Visser WI, McCaul M. Pharmacological interventions for periorificial (perioral) dermatitis in children and adults: a systematic review.J Eur Acad Dermatol Venereol 2022;36(3):380–390. doi:10.1111/jdv.17817.
- Searle T, Ali FR, Al-Niaimi F. Perioral dermatitis: Diagnosis, proposed etiologies, and management.J Cosmet Dermatol. 2021;20(12):3839–3848. doi:10.1111/jocd.14060.
About the Author
This page has been written and/or medically reviewed by Dr Sajjad Rajpar, Consultant Dermatologist and Medical Director of Midland Skin, Birmingham.
Dr Rajpar is on the GMC Specialist Register in Dermatology and has over 20 years’ experience in clinical dermatology. He provides clinical oversight to ensure the information on this page is accurate, balanced and consistent with current dermatology practice.
Dr Sajjad Rajpar
Date last updated: 24th Aug 2026
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