Facial rashes are distressing, due to their obvious location. Several types of facial rashes tend to occur primarily around the mouth, or periorally. The appearance of the rash, its specific distribution on the face, as well as other factors help distinguish among the various causes of a rash around the mouth. It's important to see your doctor for an accurate diagnosis and appropriate treatment.
Perioral dermatitis appears as a pimple-like rash but without blackheads or whiteheads. Redness occurs in the affected areas, typically the folds around the nose and mouth, and the chin. Notably, the skin immediately around the lips is spared and the rash usually affects both sides of the area around the mouth. In some cases, the skin at the outer edge of the eyes is also involved. Burning, skin sensitivity and light flaking are common. Although the exact cause of perioral dermatitis remains unclear, risk factors include use of:
-- topical steroid creams, steroid inhalers or nasal steroid sprays
-- facial cosmetics, moisturizers and high-SPF sunscreens
-- fluoridated toothpaste or mouth rinses
Perioral dermatitis most commonly affects young women and children of any age. Heat, sun exposure and oral contraceptive use may aggravate the condition. Treatment typically involves elimination of products that could be triggering the condition, along with topical or oral antibiotics.
Contact dermatitis refers to a rash caused by direct exposure to a chemical irritant or allergy-provoking substance. Contact dermatitis can occur around the mouth due to exposure to lip makeup, hair removal products, shaving cream, aftershave, or other products used primarily in the affected area. A habit of holding a pencil, pen or necklace in your mouth, or contact with metal or reeds from musical instruments held in the mouth could potentially trigger a reaction. Drooling in infants and toddlers, and habitual licking of the skin around the mouth can also lead to perioral contact dermatitis. Redness and itchiness characterize a contact dermatitis rash. There may be bumps and small, fluid-filled blisters. Infection can occur due to scratching the skin. The distribution of the rash follows the area of contact with the irritating substance.
Treatment for contact dermatitis around the mouth involves avoiding use of products causing irritation or an allergic reaction. A low-dose steroid cream might be recommended for short-term use until the rash clears.
Impetigo is a superficial skin infection caused by the bacteria Staphylococcus aureus or Streptococcus pyogenes. The infection most often occurs after something causes minor breaks in the skin, such as bug bites, cold sores, or irritation due to sweating and rubbing the skin. The rash typically begins with red, pimple-like bumps that quickly develop into pus-filled blisters. The blisters rupture easily and contain bacteria, which are highly contagious. The bumps then form yellowish-brown crusts and heal. The area around the mouth is a common site for impetigo, although it frequently also affects the hands, arms, legs, and diaper area in babies.
Impetigo occurs most commonly in young children, although the condition can affect anyone. People with an ongoing skin condition, like eczema, and those with diabetes have an increased risk for impetigo. Treatment typically involves use of a topical or oral antibiotic.
A number of other conditions can cause a rash around the mouth -- although in most cases, the rash is not limited to the perioral area. For example, seborrheic dermatitis causes a red, itchy, flaky rash that commonly occurs around the nose and mouth, as well as on the skin of the scalp, ears, eyebrows, chest, back, armpit and groin. The rash is due to a inflammatory reaction to a type of yeast called Malassezia, which is a common inhabitant of the skin. Tinea barbae is another type of fungal infection affecting the areas of the adult male face covered by beard hair. Topical or oral antifungal medications are the mainstay of treatment for seborrheic dermatitis and tinea barbae.
Other causes of a perioral rash in men include folliculitis barbae and pseudofolliculitis barbae, both of which affect the beard area. Folliculitis barbae is a bacterial infection of the beard hair follicles. Pseudofolliculitis barbae is caused by inflammation rather than infection of the beard hair follicles, typically caused by shaving. Rosacea is another skin disorder that can cause a rash around the mouth, particularly among light-complected, middle-aged adults. Flushing of the facial skin, broken blood vessels and widespread involvement of the face helps distinguish rosacea from other causes of a perioral rash.
Next Steps and Cautionary Notes
An accurate diagnosis is the key to getting rid of a rash around the mouth, since treatments differ greatly among the various causes. See your doctor as soon as possible for any persistent rash around your mouth, to speed your recovery and avoid spread of infectious causes. Seek medical care right away for any rash accompanied by a fever or that appears to be spreading.
Reviewed and revised by: Tina M. St. John, M.D.