Perioral Dermatits: Ultimate Guide To Long-Term Healing
If you don't know what Perioral Dermatitis is, count yourself lucky. As someone who has personally been affected by this truly frustrating skin condition, our founder feels your pain if you have ever had to deal with this too! Perioral Dermatitis is a tricky skin condition, since it can be easily mistaken for acne, rosacea and even eczema.
Mount Sinai lists PD as "a skin disorder resembling acne or rosacea. In most cases, it involves tiny red pumps that form on the lower half of the face in the folds of the nose and around the mouth."
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 (many) recommendations, from products to habits to laundry detergent. 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 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 an 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 perioral dermatitis
- Fluoride in toothpaste triggers perioral dermatitis
- Heavy creams and facial oils can trigger perioral dermatitis
- Hormonal fluctuations often trigger perioral dermatitis
- Stress is almost always a factor in perioral dermatitis
The condition can also be exacerbated by excessive consumption of coffee or cinnamon.
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) can sometimes contain other ingredients that can make perioral dermatitis worse (like petrolatum or mineral oil), but oral antibiotics may be helpful in the short term. Outside the dermatologist’s office, there are many simple ways to heal your skin, from natural skincare products to switching your laundry detergent.
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 the next section.
- Switch your skincare gradually to Osmia 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 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.
- 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.
WHAT ARE THE HEALING STAGES OF PERIORAL DERMATITIS?
The healing stages of perioral dermatitis 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!
WHICH PRODUCTS ARE BEST FOR PERIORAL DERMATITIS?
SKINCARE
Osmia Black Clay Facial Soap While it wasn’t designed as a perioral dermatitis soap, this little bar seems to help lots of people with perioral dermatitis! When I first started using it eleven years ago, I finally saw my dermatitis start to calm down after years of dealing with it. To get started, use the soap once a day in the evenings to start. 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 begin to wash the skin with gentle, circular motions. Continue this 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 closed. Rinse thoroughly, and pat the skin dry with a clean washcloth. Increase to twice a day if your skin is improving.
Osmia Purely Simple Face Cream 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.
Lip Doctor Use as needed for dry lips.
After three weeks of slow improvement, consider adding:
Osmia Nectar Nourishing Drops Add 1-2 drops to your Purely Simple Face Cream once your dermatitis has started to heal significantly.
Note: If you are having trouble with any of these products, please email us at help@osmiaskincare.com. Often, we can adjust the routine slightly to help you succeed.
Pick any Osmia Body Soap, with a soap saver and a travel bag. (Oh So and Oh So Detox are unscented.)
Follow with an Osmia Body Oil on wet skin, instead of a lotion with more ingredients. (Naked is unscented.)
MAKEUP
Saie Beauty's Slip Tint (tinted SPF) and Dew Blush are awesome.
W3LL PEOPLE Bio Correct concealer and/or Bio Baked Foundation
W3LL PEOPLE Bio Tint SPF 30 (this is thick, so it’s best mixed with a bit of the Purely Simple Face Cream so it doesn’t pull the skin while you’re applying)
Alima Pure Satin Matte Foundation
HAN cheek and lip tint, and lip gloss
Shop this blog post for other makeup suggestions.
SUNSCREEN
Mychelle unscented SPF 28 (you can also mix this with the Saie Slip Tint or the W3LL PEOPLE Bio Tint for a little extra coverage)
HAIR CARE
Desert Essence Unscented Shampoo and Conditioner
Josh Rosebrook shampoo and conditioner (pick the ones that seem suited to your hair)
Innersense products, from shampoo and conditioner to leave-in styling products.
DENTAL CARE
Jason Seafresh toothpaste
NUTRITION
Organic fruits
Organic vegetables
Whole, protein-rich grains like quinoa and millet
Raw honey
Black or green tea
Almond, oat, or hemp seed milk
Anything else that nourishes and supports your body during this time of healing
SUPPLEMENTS
Deva Evening Primrose Oil Supplements (Start with two pills a day, decrease to one a day after one week or when skin begins to heal.)
HOUSEHOLD PRODUCTS
Molly’s Suds Laundry Detergent
Branch Basics everything, from cleaning the house to laundry to dishwasher.
Supernatural cleaning products
Osmia hand soap (pick a favorite) with a soap saver
STRESS MANAGEMENT
Liquid melatonin to support sleep if needed.
Magnesium at bedtime can relax both mind and body.
Websites like Yoga to Cope and Glo offer amazing classes and resources for moving your body and settling your mind.
Flower elixirs to ease anxiety.
This meditation stool is very comfortable (use code Sarah10), or a less expensive pillow.
Insight Timer and Waking Up meditation apps
HOW LONG DOES PERIORAL DERMATITIS TAKE TO HEAL?
PD can get better quickly when treated with steroids, but as soon as you withdraw the steroids, your skin will likely become worse than ever. 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. Remember, perioral dermatitis often 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, a stressful event, or 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 FAQS:
— 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 2-4 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), 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.