Have you been treating persistent acne around your mouth and on your chin? Has it never gone away no matter what acne creams and treatments you use? Is this acne something that appeared once you started wearing a face mask? There is a chance that your acne is something else entirely – and that your acne cream is making it worse.
Skin rashes are often difficult to tell apart at the best of times, even for doctors. In some cases, it’s not that important to get an exact diagnosis, as many rashes are treated with the same medications.
Periorificial dermatitis is a common problem of the facial skin that is characterised by patches of itchy or tender, small, red papules, vesicles (clear fluid-filled bumps) or pustules (white fluid-filled bump). It occurs around the eyes, nose, mouth, and occasionally the genitals. If it presents on the lower half of the face it is sometimes called perioral dermatitis, and periocular dermatitis if it presents around the eyes.
The rash-like patches of red or flesh-coloured skin can sometimes itch or burn. While some patients report not itching or burning whatsoever, most will have dry, flaky skin where the rash is.
It is most commonly found in women (25-45 years old) who are using a topical steroids, and children of any age. Perioral dermatitis rarely presents in men. Perioral dermatitis can last for a duration of weeks, months, or years even with treatment.
While there is yet to be one exact cause, doctors and skin experts have identified a number of possible causes:
The exact cause of periorificial dermatitis is not understood. Periorificial dermatitis may be related to:
- Skin barrier dysfunction
- Activation of the immune system
- Changes in microorganisms that live on the skin
- Follicular fusiform bacteria
Periorificial dermatitis could be induced by:
- Topical steroids (applied deliberately to facial skin or inadvertently)
- Nasal steroids, steroid inhalers, and oral steroids
- Heavy cosmetic cream, makeup, and sunscreen
- Fluorinated toothpaste
- Poor facial hygiene
- Changes in hormones (pregnancy, oral contraceptives, hormone replacement therapy)
Treating Perioral Dermatitis
So, your acne may be perioral dermatitis, that means a trip to a doctor, dermatologist or online telemedicine provider will be necessary.
There are a number of medications that can help clear up perioral dermatitis. You should bear in mind that these medications will not fix the problem overnight, sometimes taking weeks or months to see an improvement. Your healthcare provider may recommend one or more of the following treatments.
Topical medications like erythromycin gel, clindamycin lotion or gel, metronidazole cream or gel, azelaic acid, and adapalene. Sometimes oral antibiotics are prescribed to reduce inflammation, these include tetracycline, doxycycline, oral erythromycin, and low-dose oral isotretinoin. Topical treatments are regularly used in conjunction with antibiotics.
But what can you do in the meantime? Cease and desist with all the face creams/serums that you are using (including topical steroids, cosmetics, and sunscreens). If you are using any topical steroids or creams it is suggested that you slowly discontinue use. When it comes to washing your face, warm water on its own is more than enough while the rash is still present.
Consider a slower withdrawal from topical steroid/face creams if there is a severe flare after steroid cessation. Temporarily, replace it by a less potent or less occlusive cream or apply it less and less frequently until it is no longer required. Only wash your face with warm water while the rash is present.
A Recent Rise In Cases
As a result of the COVID-19 pandemic, there has been a rise in perioral dermatitis cases (sometimes mistaken for maskne) due to the wearing of face masks. This is because a mask covering part of your face for prolonged periods of time changes the skin environment, which in turn affects the skin barrier. If you have skin that is sensitive or prone to inflammation you are more likely to experience a breakout of perioral dermatitis.
The Difference Between Perioral Dermatitis And Acne
Acne is an incredibly common skin condition, affecting up to 85% of the world’s adolescents and young adults. Adult acne can also occur at any time, and to anyone.
It is a chronic inflammatory disease that encompasses clogged pores called comedones, which can be open (blackheads) or closed (whiteheads), papules (small red bumps) and pustules (papules that are filled with pus), as well as large, painful, and inflamed nodules and cysts (blind pimples). Redness, hyperpigmentation, scarring, and pain are also common.
Some clues to help you figure out that you’re not dealing with acne: You have breakouts that appear as many small pimples, however it develops only around the mouth, nose, and eyes. The bumps are surrounded by a red rash that is dry and flaky, this rash might also itch and/or burn.
Acne differs from perioral dermatitis in that it causes comedones, the spots tend to be larger and reach deeper into the skin, and acne usually leaves behind scarring. It is important to bear in mind that you can have both acne and perioral dermatitis at the same time.
So It Turns Out That You Don’t Have Perioral Dermatitis…
Then it means your acne creams and skincare products are not working to clear up your breakouts. Why is this happening? Over the counter (OTC) remedies come up short when treating acne-causing pathways – which means they only treat the symptoms and not what is actually triggering your breakouts. Visit a dermatologist or telehealth provider so they can formulate a prescription acne cream unique to your skin’s needs.
Treating perioral dermatitis and acne can be a long and frustrating process. This is why skin health experts, Qr8 MediSkin, have a Skincare Support Team that provides advice and follow-up care for all their patients. This includes access to guides that will help you minimise retinization (irritation, peeling and redness) and purging (temporarily getting more pimples before your acne clears). They can even help you find the perfect sunscreen to add to your skincare routine.