Perioral & Periorificial Dermatitis

Perioral dermatitis takes its name from where it classically appears, "perioral" literally means around the mouth. Similar rashes around the eyes (periocular dermatitis) or nose (perinasal dermatitis) are closely related, and together these are sometimes grouped under the umbrella term periorificial dermatitis. In practice, many people use "perioral dermatitis" loosely to cover all three, and everything on this page applies whichever term fits your case.

Perioral Dermatitis can be extremely distressing, particularly as it manifests on the face, and it has a habit of being made worse by exactly the instinct most of us have when skin looks irritated: reaching for more product. If there's one thing worth knowing before anything else on this page, it's that less is very often more with this condition.

Topical products are only part of the picture with perioral dermatitis. This page covers what's going on underneath: the common triggers, the steroid connection, and the diet, gut and stress factors worth looking at. When you're ready to choose products, our natural perioral dermatitis treatment routine sets out the Lyonsleaf approach step by step.

What Causes Perioral Dermatitis

The exact cause isn't fully understood, but several triggers come up consistently. Working out which apply to you is often more useful than the list itself:

  • Steroid creams, even mild ones, used on the face, and steroid inhalers in children
  • Heavy or occlusive moisturisers and cosmetics. Mineral oil and petrolatum, petrochemical-derived ingredients common in conventional creams, are frequent culprits, along with heavy foundation. Among natural oils, coconut oil and lanolin are genuinely occlusive too and can have the same effect, but most other plant oils are not occlusive.
  • Sodium lauryl or laureth sulfate (SLS), a foaming agent in toothpaste, cleansers, face washes and hair care products
  • Mint and cinnamon flavourings, in toothpaste, gum and mints, both are genuinely well-documented triggers
  • Hormonal fluctuations. PD disproportionately affects women, and it's a recognised cause in its own right, not just an anecdotal pattern. If your flares track closely with your menstrual cycle, pregnancy, or starting or stopping hormonal contraception, hormones are likely playing a role for you specifically. Any decision about contraception itself is one to make with your doctor, not something to change based on a skin concern alone
  • Gut health. Worth considering more strongly if you also have regular bloating, constipation, diarrhoea or discomfort after eating, if your skin reacts to specific foods like dairy, gluten, or histamine-rich foods such as aged cheese and fermented foods, or if your rash started or worsened after a course of antibiotics, which can disrupt gut bacteria. See our Gut-Skin Axis page
  • Stress. A flare that appears or worsens within a couple of weeks of a genuinely stressful event, or one that recurs in step with a repeating stressful pattern, like work deadlines or a run of poor sleep, points towards stress as a real factor for you, rather than coincidence

Perioral Dermatitis or a Damaged Skin Barrier?

A compromised skin barrier is one of the recognised underlying causes of PD, which is exactly why the two get confused, they're often genuinely connected, not just similar-looking. A few things help tell them apart:

  • Pattern. Barrier damage tends to be widespread, affecting your whole face or wherever a harsh product was used. PD forms distinct, localised clusters of small bumps specifically around the mouth, nose or eyes, often with a thin strip of completely clear skin right next to the lips themselves.
  • Texture. Barrier damage tends to feel flaky, raw or tight, without the inflamed, pimple-like bumps clustering in one area. PD has those bumps.
  • Sensation. Barrier damage often stings with almost anything you apply, even a plain moisturiser. PD's burning or itching tends to stay localised to the bumpy area itself.

It's genuinely possible to have both at once, a damaged barrier can be the underlying cause of PD, and over-treating PD with too much product can separately damage the barrier further. If your symptoms are widespread rather than localised, our Natural Skincare Routine for Dry & Sensitive Skin is the one to follow for the rest of your face. Keep our natural perioral dermatitis treatment routine just for the localised bumpy patches themselves, since that's where less product, not more, matters most.

A Possible Histamine Connection

Some people find their perioral dermatitis flares alongside high-histamine foods, cheese, wine, cured meats and similar. This link isn't widely accepted or proven in mainstream dermatology, but enough people report it that it's worth knowing about.  Our Histamine Sensitivity and Intolerance page covers the common triggers, and some simple ways to help keep your histamine load in check.

Perioral Dermatitis and Steroids

Steroid creams, even mild ones, are a recognised cause of perioral dermatitis, this can happen simply from using them on the face, including accidental transfer from steroid inhalers in children, without any withdrawal being involved. The British Association of Dermatologists states plainly that steroid creams are a cause of the condition.

There's also a separate, related picture worth knowing about: when steroids are stopped after prolonged use, some people experience a withdrawal reaction, topical steroid withdrawal (TSW), and in children particularly, this has been reported to present in a perioral pattern that looks clinically like perioral dermatitis, even though the underlying process is withdrawal rather than ongoing steroid use. If your rash has appeared or worsened since stopping a steroid cream, rather than while using one, TSW is worth ruling in or out. See our Topical Steroid Withdrawal page for how to tell the difference.

If you're using a steroid cream and wondering whether to stop, please do this with your doctor, particularly if you've used it for a long time or on a large area, stopping suddenly can affect the adrenal glands in some cases.

If you do see your doctor, it's worth taking a printed copy of the BAD's patient information leaflet on perioral dermatitis with you, or, if TSW seems relevant, ITSAN's resources for doctors. Many customers tell us their doctor's first instinct is simply to prescribe another steroid cream, having something in hand that addresses this directly can make for a more useful conversation.

The Lyonsleaf Approach

Because heavy products can prolong a flare, our approach is deliberately minimal. Cleanse gently with an oil cleanse, apply a thin layer of Zinc and Calendula Cream straight onto the bumps, and moisturise the rest of your face lightly, if at all. Our balms are based on plant oils rather than mineral oil, coconut oil or lanolin, so they're not occlusive in the way that drives PD.

For the full routine, including how often to apply, make-up tips and where to start if you're new to us, see our natural perioral dermatitis treatment routine.

    Check Your Toothpaste and Hair Products

    Fluoride and SLS are two of the most consistently reported triggers for PD, both are common in toothpaste, and SLS also turns up in cleansers, face washes and hair products. If your hair brushes against your face, product transferred from it can trigger or worsen a flare too, worth considering if the affected area lines up with where your hair makes contact. Fluoride-free, SLS-free toothpaste is widely available without a prescription. If you switch to a fluoride-free toothpaste, hydroxyapatite is a common alternative, look for one using micro- rather than nano-sized particles. See our Ingredients We Avoid page for why we prefer non-nano formulations generally.

    Mint and cinnamon flavourings, in toothpaste, mints and chewing gum, are also genuinely well-documented triggers, not a fringe theory. If you can't immediately place a cause, switching to an unflavoured or mildly flavoured toothpaste for a few weeks is a simple thing to try.

    See our Skin Irritants page for the fuller list of everyday irritants worth knowing about.

    Diet and Gut Health

    A varied, healthy diet is a good starting point, see our Foods for Healthy Skin page. Gut health specifically is worth attention too, a probiotic, ours is called Multibiotic, or probiotic foods, can help support a healthy balance of gut bacteria. See our Gut-Skin Axis page for the fuller picture.

    Stress

    Stress is a well-known trigger for flares, and cortisol acts directly on the skin. There are many ways to manage stress, but one thing not many people talk about is managing your blood sugar. This is a very practical and simple way to help your body handle stress better, see our Stress, Blood Sugar and Skin Health page.

    Where to Find Support

    There are many perioral dermatitis support groups on platforms like facebook. Obviously this is not a place to find medical advice, but the support and shared knowledge of other sufferers can be very helpful. If your perioral dermatitis isn't improving, is spreading, or you suspect it's related to steroid use, your GP or a dermatologist can help confirm what's going on and rule out anything else, although you may want to go prepared with resources from groups like ITSAN or the British Association of Dermatologists. A nutritional therapist is a good next step for investigating diet and gut health specifically.