Perioral dermatitis sucks. There, I said it, and now we are all in agreement. I have had dermatitis for twelve years. Before you panic, let me be clear: for the last ten of those years, I've been symptom-free. After trying everything from apple cider vinegar to yogurt to antibiotics, I took matters into my own hands and formulated products myself. Combined with simple lifestyle modifications, these products have helped my skin recover from perioral dermatitis, and after a decade in business, our products have now helped many thousands of faces like mine. I still use Black Clay Facial Soap and Purely Simple Face Cream every single day, and I still follow all the lifestyle recommendations—if I don't, my symptoms will start to reappear.
Here's a medical summary of the condition, and my recommendations for getting started on your healing journey. This plan works best if you read it carefully, follow it very closely, and give your perioral dermatitis enough time to heal for the long term.
For a printable guide to healing your perioral dermatitis, click here. Not sure you have time to read right now? Check out our perioral dermatitis collection here:
WHAT IS PERIORAL DERMATITIS?
Perioral dermatitis (PD) is a very common condition of the facial skin (perioral means “around the mouth,” and dermatitis means “inflammation of the skin”). It varies in severity, and often affects women of childbearing age, but can also affect men, older women, and children. In mild cases, it consists of patches of slightly bumpy, red, or irritated looking skin, often with mild flaking and tightness of the skin around the mouth, chin, and nose. Some people may experience symptoms near the outer corners of the eyes as well, which is called periocular dermatitis. In severe cases, the skin becomes very inflamed and angry looking in those areas, with flakes or scabs that can bleed or become infected. Many cases of perioral dermatitis look like simple acne, but are focused around the chin and the smile lines around the mouth and nose.
Perioral dermatitis is frequently undiagnosed or misdiagnosed, and often acts like a cross between acne and eczema, making it especially troublesome to treat. It’s helpful to think of PD as a number—let’s say the number 50. You can get to fifty by adding 49+1, or 48+2, or 20+25+5, or countless other combinations. The same is true for PD: while one person’s symptoms may be from stress and pregnancy, another person’s may be from fluoride toothpaste, and yet another’s from topical steroid withdrawal. The symptoms look the same, but the underlying causes are multiple, variable, and unique to each person’s case. In addition, what triggers your perioral dermatitis one time can differ from what triggers it another time. Tricky, right?
WHAT DOES PERIORAL DERMATITIS LOOK LIKE?
These are photos sent in to us by people with PD who have approved them for anonymous use in this article. We hope they give you a sense of how different the condition can look for each person.
(Photo collage by Osmia—may not be used without written permission.)
WHAT CAUSES PERIORAL DERMATITIS?
One of the leading causes of perioral dermatitis is withdrawal from topical steroids. Dermatologists prescribe steroid creams and lotions for various conditions, and when patients try to stop using them, they find that their skin responds by bursting into this angry rash. Fortunately, many dermatologists are becoming aware of this and decreasing their liberal use of topical steroids.
The other main causes of perioral dermatitis, which often occur in combination, are these:
- Sodium lauryl/laureth sulfate in hair care, in laundry detergent, and in toothpaste can trigger or exacerbate perioral dermatitis
- Fluoride in toothpaste triggers and exacerbates perioral dermatitis
- Heavy creams and facial oils can trigger or exacerbate perioral dermatitis
- Hormonal fluctuations often trigger perioral dermatitis
- Stress is a factor in the vast majority of cases of perioral dermatitis, and can often be worsened by the condition itself
- Excessive coffee and/or cinnamon can trigger or exacerbate perioral dermatitis.
HOW IS PERIORAL DERMATITIS TREATED?
For many years the condition was treated with topical steroids, which created an endless, miserable cycle. Most dermatologists are up to speed now, and will not recommend steroids. They often recommend tacrolimus (Protopic) and picrolimus (Elidel), which are immunosuppressive creams similar to steroids, although with less of a withdrawal effect. Other options in the dermatologist’s office include topical or oral antibiotics. Topical antibiotics (creams and ointments) often contain other ingredients that can make perioral dermatitis worse (like petrolatum or mineral oil), but oral antibiotics can sometimes be helpful in the short term. Outside the dermatologist’s office, there are many simple ways to heal your skin, from specific natural skincare products to switching some of the other products in your home.
HOW CAN I TREAT PERIORAL DERMATITIS NATURALLY?
The trouble with many dermatology visits is that the solutions are temporary. By making a few modifications to your life, your home, and your skincare routine, you can create lasting change. Here are ten critical steps, with lots more detail in this blog post.
- Switch your skincare gradually to Osmia’s Black Clay Facial Soap and Purely Simple Face Cream. Do not use facial oils or balms of any kind. Do not exfoliate if your skin is not healed.
- Wean any topical steroids or immunosuppressants very slowly, with the approval of your healthcare provider. You can blend them with the Purely Simple Face Cream, decreasing the amount of prescription cream over the course of seven to ten days.
- Remove ALL sodium lauryl/laureth sulfate from your home. This includes shampoo, toothpaste, laundry detergent, and hand soap or body wash. You’ll have to read every label because even natural brands use SLS. Here are some tips for getting started.
- Switch to a non-fluoride toothpaste.
- Limit coffee and cinnamon products.
- Limit makeup as much as possible initially.
- Maintain excellent hydration and work toward an anti-inflammatory, plant-rich diet.
- Consider an evening primrose supplement if you’re not trying to conceive. (If you do become pregnant, you can stop the supplement. It is safe for breastfeeding.)
- Keep a journal once a week about the changes you’re seeing in your skin so you can have a timeline and notes while your perioral dermatitis is healing. If you like, you can take a photo in the same spot at the same time of day once a week to monitor changes in your skin’s appearance, but other than that, try not to spend too much time in front of the mirror!
- Address the stress in your life. Stress management is critical in supporting your skin, since stress is one of the main triggers for PD. This means active stress management like meditation, exercise, or therapy.
WHAT ARE THE HEALING STAGES OF PERIORAL DERMATITIS?
The signs that perioral dermatitis is healing can look different for everyone. Sometimes the symptoms slowly start to recede, with less redness and irritation. Sometimes it gets a bit more red or dry as it heals. Sometimes it gets noticeably worse before it gets better, especially if you’ve used steroids recently. There’s no one pattern to the way perioral dermatitis heals, but it’s usually slow progress! You should expect your skin to take 4-6 weeks to show significant improvement, and if it happens faster, it will be a lovely surprise.
WHICH SKINCARE PRODUCTS ARE BEST FOR PERIORAL DERMATITIS?
When I first formulated this bar and started using it twelve years ago, I finally saw my perioral dermatitis start to calm down after years of dealing with it. Since then, this facial bar has helped thousands of people with skin conditions like perioral dermatitis, eczema, and acne. To get started, use the soap once a day in the evenings. To use, splash your face and the bar with lukewarm water. Rub the bar vigorously between your hands until you have a thick, creamy lather. Place your soap on a soap saver, and wash your face with gentle, circular motion for 30-60 seconds, using very light pressure. If you need to remove eye makeup as well, save it for the last few seconds of cleansing, and keep your eyes firmly closed. Rinse thoroughly, and pat the skin dry with a clean washcloth. Increase to twice a day if your skin is improving. This bar removes makeup thoroughly, and a double cleanse is not necessary.
Apply after cleansing once a day, use this gentle, perioral dermatitis-safe moisturizer, applying it sparingly over the angry areas of your skin. Increase to twice a day if your skin is improving.
Both the soap and the face cream are included in this perioral dermatitis kit, which is available in both trial and full sizes.
Lip Doctor Use as needed for dry lips.
After three weeks of slow improvement, consider adding:
This unscented, aloe-based hyaluronic acid serum is often a much-needed layer of hydration for skin with perioral dermatitis, which wants water-based ingredients above all else. It also contains a caper extract that is very soothing to inflamed skin. Try a sample first before using the full size, as every face is different, and you want to make sure your skin likes this new product, especially if you're in healing mode!
Add 1-2 drops to your Purely Simple Face Cream once your dermatitis has started to heal significantly. This can help fortify your barrier layer, and will help your skin hold in moisture more effectively.
Note: If you are having trouble with any of these products, please email us at email@example.com. Often, we can adjust the routine slightly to help you succeed.
For other products in your home that need to change to support your skin in recovering from perioral dermatitis, please read this blog post!
HOW LONG DOES PERIORAL DERMATITIS TAKE TO HEAL?
Perioral dermatitis can get better very quickly when treated with steroids, but as soon as you withdraw the steroids, your skin will likely become worse than ever—I promise it's not worth it. Oral antibiotics can produce results within 2-4 weeks, but if you have not made lifestyle changes to support your skin, your symptoms will likely reappear as soon as you're off the antibiotics and your stress level increases.
Making changes more slowly gets results more slowly, but the results can last a lifetime! Following our perioral dermatitis plan, people usually start to see improvements within 4-6 weeks, if not a little sooner. Remember that your perioral dermatitis acts as a barometer for your body, letting you know when things are out of balance. Your symptoms may go away entirely, but using the wrong products, having a stressful event, or experiencing a hormonal shift can bring the rash back to the surface again. If that happens, it simply means your skin is telling you that you need to figure out what shifted, and gently bring it back into balance by following these steps again, carefully and completely.
PERIORAL DERMATITIS FREQUENTLY ASKED QUESTIONS
—Can you get rid of perioral dermatitis overnight?
Nope. No matter what the internet tells you at 2am, perioral dermatitis takes time to heal. With this protocol, you should expect to see change within 4-6 weeks. If you only take some of the steps in this perioral dermatitis plan, you should expect it to take longer to improve.
—What is the difference between perioral dermatitis vs eczema?
Perioral dermatitis and eczema (also called atopic dermatitis) are both forms of dermatitis—think of them as first cousins. Perioral dermatitis is limited to the skin around the mouth, chin, and nasolabial folds (smile lines), and near the eyes, while eczema can happen anywhere on the body. This protocol will be helpful for both conditions, as many of the triggers for eczema are the same as perioral dermatitis triggers.
—How can I tell if perioral dermatitis is healing?
Signs that your perioral dermatitis is healing include decreased redness and dryness, and fewer bumps. Sometimes there is a period of increased redness or dryness before noticeable healing begins, but ultimately you should see more areas of healthy, hydrated skin as your dermatitis starts to resolve.
—Is perioral dermatitis bacterial or fungal?
It’s unclear if bacteria or fungi play a role in perioral dermatitis. Some people believe that demodex mites can cause perioral dermatitis, but they actually cause a condition called folliculitis that is treated differently than perioral dermatitis. Antibiotics can help treat perioral dermatitis, but it’s unclear if the mechanism is attributed to specific antibacterial activity or to breaking a cycle of chronic inflammation in the skin.
One last note: the stress management piece of this puzzle must not be ignored. Stress causes the release of a number of hormones in the body, all of which can affect your skin. Because stress is a natural part of human existence, we all need daily, mindful practices to mitigate the effects of stress on your body and mind. If you’re not sure how or where to start, read this.
Ready to get started? Check out our PD Collection here:
Please email us at firstname.lastname@example.org with any questions. Our team speaks the language of perioral dermatitis, and we would love to help you on your journey to healthier, happier skin.