Perioral Dermatitis: An Acne Look Alike
Pimples around the mouth in adult women are often diagnosed as acne, but many times it's actually perioral dermatitis. Perioral dermatitis is an acne-like eruption that presents as red bumps on the chin and mouth. Like dermatitis, the skin can be red, scaly and itchy; like acne, it can have pimples.
Perioral dermatitis usually starts as pimples around the mouth; in more severe cases, the bumps appear around the nose and eyes as well. It has a characteristic circular pattern, surrounding the mouth while sparing a thin border of skin around the lips. Unlike acne, there are no clogged pores (comedones) in perioral dermatitis.
Women and Children Are Affected
Perioral dermatitis occurs mostly in adult women. It is possible, though unusual, for men to develop it. It usually affects women in their twenties to forties and is chronic, lasting months to years. Perioral dermatitis can also occur in children. In contrast to adults where only women are affected, both boys and girls can get the disease.
Steroids and Makeup Make Perioral Dermatitis Worse
Applying topical steroids to your face is a risk factor for developing perioral dermatits. Topical steroids that can cause the problem include both over the counter products such as hydrocortisone as well as prescription steroid creams.
A typical scenario is that a woman develops dryness or itchy pimples on her face and so applies a topical steroid (often prescribed by her physician). The steroid seems to clear up the rash at first, but then more acne-like bumps develop. The more topical steroid she uses, the worse the perioral dermatitis becomes.
Using foundation makeup or applying heavy moisturizing cream on a daily basis also seems to trigger perioral dermatitis. The fact that women apply moisturizers (and makeup) more often than men is one of the reasons the disease occurs almost exclusively in women.
Oral Antibiotics Are Effective Treatment
The most effective treatment for perioral dermatitis is oral antibiotics. Commonly used therapies include doxycycline, minocycline and erythromycin. The rash usually improves after 2 to 3 weeks of therapy, although a month or more of antibiotics is needed to completely eliminate it. Topical antibiotics such as metronidazole cream can also be used, but are usually not as effective as oral antibiotics.
It is important that all topical steroid creams be stopped. Applying any type of steroid to the face can cause the rash to quickly reappear.
Diet Can Affect Perioral Dermatittis
Like with rosacea, eating hot or spicy foods can exacerbate perioral dermatitis. This is because foods that dilate blood vessels and increase inflammation in the skin can make the red, inflamed pimples worse. Examples of foods that might trigger an outbreak include sour cream, yogurt, citrus fruit, vinegar, cinnamon, hot sauce and spices. Sometimes it helps to keep a food diary; when you notice foods that exacerbate your perioral dermatitis, make a note of it so you can avoid them in the future.