When is Acne Not Acne? When It's Perioral Dermatitis

Updated: Nov 8, 2018

Dr. Jan Newell published the following: The patient presenting with this concern is most often female and is experiencing small blisters or spots around the mouth, chin and nose (most often concentrated within the nasolabial grooves. The skin around the edge of the lips is usually spared and is clear. The skin affected may be dry and flaky and there may be an itchy or burning sensation. What distinguishes this from acne is the lack of clogged pores or comedones.


The exact cause of perioral dermatitis is unknown but it can be aggravated by skincare containing a high quantity of oils, steroid nasal sprays or topical steroid ointments. There is also some evidence that perioral dermatitis may be triggered by hormonal causes since it is most often seen in women between the ages of 20 and 50 and rarely presents in men or children. Another possible trigger is irritation caused by sodium laurel sulfate and fluoride in conventional toothpastes. Quite often it is caused by a combination of the previously mentioned triggers.


The first thing I do when someone comes in to see me presenting with perioral dermatitis is suspend their current skincare routine. I then put together a non-comedogenic routine that is low in oils but still nourishing to the skin. Typically this adjustment in routine is enough to solve the problem. For additional skin health support, I include vitamins and minerals as well as botanical remedies to promote healing, reduce inflammation and encourage cellular renewal. I do warn patients that if topical steroids were the initial cause then quite often the skin gets worse before it gets better but it does get better with time (so long as you discontinue the steroids). More severe cases may require topical azalaic acid (compounded at 15-20%) and oral antibiotics. While I do try to avoid the oral antibiotics and opt to use antimicrobial herbs in their place to start, there are cases where the antibiotics are the best option when all else has failed.

I have found that those patients that take a comprehensive approach to treating perioral dermatitis that includes eliminating possible triggers, alleviation of symptoms and regeneration of healthy skin cells tend to achieve resolution more quickly than those that only integrate one step in their healing process. If you are struggling with persistent perioral dermatitis then it may be time to consult with a Naturopathic Doctor with experience treating it.

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My blog page is full of helpful information on maintaining healthy skin.