Periorificial Dermatitis: Causes, Symptoms, and Treatment

Periorificial Dermatitis is a chronic inflammatory condition that affects the skin around the mouth, nose, and eyes. The Periorificial is characterized by perioral dermatitis symptoms (red papules, pustules, and inflammation), which are irritated by factors (use of topical steroids), skin care products, or hormonal fluctuations. Environmental triggers, stress, and microbial factors (Demodex mites), while the exact perioral dermatitis causes remain unclear, are believed to contribute to its development.

Perioral dermatitis treatment involves discontinuing the use of topical corticosteroids, which flare up. Topical antibiotics (metronidazole) or oral antibiotics (tetracyclines) are prescribed to reduce inflammation and infection. Managing triggers, including avoiding known irritants and practicing a gentle skin care routine, is essential for controlling outbreaks and minimizing the recurrence of perioral dermatitis.

What is Periorificial Dermatitis?

Periorificial or perioral dermatitis is a chronic inflammatory condition affecting the perioral region, but it extends to the perinasal and periocular areas. The periorificial area presents as erythematous papules, pustules, and vesicles, accompanied by a scaly or flaky surface. The condition is prevalent among women aged 20 to 45 years and is related to the use of topical corticosteroids. Perioral dermatitis is not a true dermatitis but a papulopustular eruption resembling acne or rosacea.

Topical corticosteroids (fluorinated variants) are connected with the development of perioral dermatitis. Other potential triggers include the use of fluorinated toothpaste, exposure to cosmetics and moisturizers, hormonal fluctuations, and microbial factors (Demodex mites and Candida species). Perioral is characterized by perifollicular inflammation with lymphocytic infiltrates and, in some cases, granulomatous changes. Treatment involves the discontinuation of topical steroids, which worsen symptoms, and the initiation of topical or systemic antibiotics (metronidazole or tetracycline derivatives). Management strategies aim to reduce inflammation, address potential triggers, and prevent repetition.

How does Perioral Dermatitis Develop?

Perioral dermatitis develops through genetic and environmental triggers. Patients with a family history of inflammatory skin conditions (rosacea or acne) develop the disorder. The condition begins when factors (use of topical corticosteroids, irritants, and the skin) initiate an inflammatory response. The results in the formation of a rash around mouth, manifesting as papules, pustules, or erythematous patches. Symptoms appear or worsen following the use of corticosteroids, which suppress the body's natural immune response and make the skin more vulnerable to infection or inflammation.

Microbial imbalances or hormonal fluctuations play roles in the perioral dermatitis develop. The presence of Demodex mites, which are found on the skin, has been related to the development of the condition, as they contribute to inflammation. Fluctuations in estrogen and progesterone levels, in menstruation or pregnancy, trigger flare-ups. Stress, excessive heat, or spicy foods are lifestyle triggers that irritate the condition, strengthening its chronic nature. Perioral dermatitis develops through a complex interplay of genetic, environmental, and microbial factors.

How does Periorificial Dermatitis Differ from Atopic Dermatitis (Eczema) on the Face?

Periorificial dermatitis is different from Atopic Dermatitis (Eczema) on the face in clinical presentations and underlying causes. Periorificial dermatitis manifests as erythematous papules, pustules, and vesicles around the mouth, nose, or eyes, triggered by topical corticosteroid use or other irritants. It presents in adults or women, and is characterized by the absence of scaling or dryness, which differentiates it from other conditions (eczema). The rash around the mouth in periorificial dermatitis is concentrated, with a more localized and specific distribution, while eczema tends to involve larger areas of the face, including the forehead and eyelids, and has dry, cracked skin.

The mechanisms behind periorificial dermatitis differ from patients with eczema. Periorificial dermatitis is thought to be caused by inflammation triggered by microbial factors 

(demodex mites) and irritation from external agents. Eczema is driven by genetic factors affecting the skin's barrier function and immune response. Pruritus (itching) is a hallmark symptom in eczema, whereas periorificial dermatitis tends to be less itchy but more prone to redness and pimples. Eczema on the face is a chronic condition, while periorificial occurs in flare-ups that are more easily managed with medication. The Atopic Dermatitis involves broader immune dysfunction and inflammation, while periorificial dermatitis is more localized and linked to external triggers.

Is Periorificial Dermatitis the Same as Perioral Dermatitis?

Yes, Periorificial Dermatitis is the same as Perioral Dermatitis. The terms refer to the same skin condition characterized by redness, papules, and pustules, occurring around the mouth but extending to the nose or eyes. The use of topical corticosteroids or other irritants most commonly triggers the condition. The term dermatitis describes an inflammatory disorder that predominantly affects the skin's surface. Presenting similarly in affected patients, despite the difference in wording.

The difference between periorificial dermatitis and perioral dermatitis is mainly semantic. The symptoms and treatment approaches remain identical, with the condition requiring the discontinuation of corticosteroids and the use of antibiotics (metronidazole) for management. Perioral/periorificial dermatitis remains a localized, chronic condition that flares up intermittently, and its therapeutic strategies are the same regardless of the terminology used.

Is Periorificial Dermatitis Similar to Seborrheic Dermatitis Around the Nose?

Yes, Periorificial Dermatitis is similar to Seborrheic Dermatitis around the nose. The conditions present with redness, irritation, and scaling around the nose, making them appear similar at first glance. The causes and clinical features differ. Periorificial dermatitis manifests as papules and pustules that are triggered by the use of topical corticosteroids or other irritants. In contrast, seborrheic dermatitis is characterized by flaky, greasy scales, related to an overgrowth of yeast (Malassezia) and oily skin. It tends to affect areas with a high density of sebaceous glands (the nose, eyebrows, and scalp).

The two conditions overlap in the area around the nose. Seborrheic has a more chronic and recurrent nature, with periods of flare-ups connected with stress, hormonal changes, or cold weather. Seborrheic Dermatitis leads to crusting and flaking with a yellowish appearance, while periorificial causes isolated, pimple-like bumps. Effective treatment for seborrheic dermatitis includes antifungal agents and topical corticosteroids, distinguishing it from the therapy for periorificial dermatitis, which focuses on discontinuing steroid use and managing inflammation.

What Causes Periorificial Dermatitis?

The causes of Periorificial Dermatitis are listed below. 

• Topical Steroid Use: Perioral dermatitis causes are not understood, but the cause of perioral dermatitis is the prolonged application of topical corticosteroids (fluorinated variants). The steroids disrupt the skin’s barrier, making it more prone to inflammatory reactions. The condition worsens when steroid use is discontinued, triggering a rebound effect that worsens the symptoms.

• Cosmetics Triggers: Perioral dermatitis triggers include factors (skin care products, cosmetics, or toothpaste with fluoride). The substances irritate the sensitive skin around the mouth, nose, and eyes, provoking an outbreak. Environmental factors (heat, sun exposure, or wind trigger flare-ups in patients predisposed to the condition.

• Hormonal Changes: Hormonal fluctuations in menstruation or pregnancy contribute to the development of perioral dermatitis. Increased estrogen and progesterone levels trigger skin changes, leading to the appearance of papules and pustules. Hormonal imbalances (polycystic ovary syndrome) worsen the condition.

• Stress: Emotional and physical stress is a known trigger for perioral dermatitis. Stress causes fluctuations in hormone levels and disrupts the immune system, which contributes to flare-ups. Patients under high levels of stress notice their condition worsening, leading to the appearance of new lesions or irritating existing ones.

• Demodex Mites: The presence of Demodex mites, microscopic organisms that live on the skin, plays a role in the development of perioral dermatitis. The mites feed on skin oils and contribute to inflammation when they multiply excessively. The presence has been related to cases of perioral dermatitis in patients with skin barriers.

• Environmental Irritants: Exposure to environmental irritants (extreme temperatures, pollution, or harsh chemicals) triggers perioral dermatitis. The irritants cause skin sensitivity, leading to inflammation and the formation of pustules. Patients who work in environments with constant exposure to irritants develop the condition.

• Food Triggers: The foods (spicy dishes, alcohol, and hot beverages) trigger or worsen perioral dermatitis. The foods increase blood flow to the skin, which leads to inflammation. Dietary modifications help reduce the frequency and severity of outbreaks, but not all patients are affected.

• Fluorinated Toothpaste: The fluorinated toothpaste acts as a trigger for perioral when used over an extended period. Fluoride causes irritation and a burning sensation, which leads to the development of papules or pustules around the mouth. Switching to a non-fluoridated toothpaste helps reduce flare-ups.

How does Periorificial Look Like?

Periorificial dermatitis looks like a skin condition with red, inflamed patches and pustules around the mouth and nose. The area appears irritated with raised red papules scattered in the skin, some of which are surrounded by dry, flaky patches. The lips appear chapped and cracked, contrasting with the redness. The skin's texture is uneven, with areas of mild swelling and irritation, appearing in the nasolabial folds and around the mouth.

The fair skin shows the flare-up of periorificial dermatitis, where the rash is most intense around the mouth and chin. The rash appears in a scattered pattern with some areas being more inflamed than others. The papules are small and clustered, showing a mix of red, irritated skin, while the surrounding skin remains slightly oily and uneven in texture. The condition emphasizes the importance of managing triggers (topical steroids and environmental factors) to reduce flare-ups.

The Periorificial dermatitis is shown in the image below. 

Can Skincare Products or Steroid Creams Trigger Perioral Dermatitis?

Yes, skincare products or steroid creams can trigger Perioral Dermatitis. The use of topical corticosteroids over extended periods is a well-known trigger for the condition. Steroid creams weaken the skin's natural barrier, leading to increased susceptibility to irritation, inflammation, and infection. It causes a rebound effect when the cream is discontinued, worsening the symptoms and triggering flare-ups of perioral dermatitis.

The skincare products containing harsh chemicals, fragrances, or alcohol irritate the skin around the mouth, nose, and eyes, contributing to the development of perioral dermatitis. The products disrupt the skin’s protective barrier, causing redness, bumps, and pustules. Patients with sensitive skin are more prone to reactions, making it essential to choose gentle, non-irritating products to avoid worsening the condition.

Is Perioral Dermatitis Caused by Bacteria or Fungus?

Yes, Perioral Dermatitis is caused by bacteria or fungi. The microorganisms have been implicated in triggering the condition, while the exact cause of perioral dermatitis remains unclear. The presence of Demodex mites, a type of microscopic mite that lives on human skin, has been related to the inflammation seen in perioral. The mites contribute to skin irritation, leading to the formation of papules, pustules, and redness around the mouth, nose, and eyes.

Fungal infections (Candida species) have been identified as potential contributors to perioral dermatitis. The fungi disrupt the skin’s balance in areas that are prone to moisture and oil accumulation (around the mouth). Bacterial infections play a role, as they worsen the condition when the skin’s barrier is compromised, making it more susceptible to external pathogens. Treating the underlying microbial imbalance through topical or systemic treatments helps manage the symptoms of perioral dermatitis.

What are the Symptoms of Periorificial Dermatitis?

The Symptoms of Periorificial Dermatitis are listed below. 

• Redness: The skin around the mouth, nose, or eyes develops a red, inflamed appearance. The redness appears in patches and varies from mild pink to deep red coloring. The affected areas look irritated and become noticeable when the condition flares up.

• Small Bumps: Tiny, raised bumps form on the skin in clusters around the facial openings. The bumps are small and red or skin-colored. The bumps appear in groups and look similar to acne, but are part of the dermatitis condition.

• Rashes: A distinctive rash develops in the area surrounding the lips and mouth. The rash around mouth is one of the most common signs of perioral dermatitis. The rash spares the area right next to the lip border, creating a clear ring around the mouth.

• Itching: The affected skin becomes itchy and uncomfortable, causing patients to want to scratch the area. The itching ranges from mild to severe and gets worse at certain times of day. Scratching makes the condition worse and leads to more irritation.

• Dryness: The skin in the affected areas becomes dry and feels tight or uncomfortable. The dryness causes the skin to flake or peel slightly. The dry patches make the other symptoms bothersome.

• Burning Sensation: Patients with the condition experience a burning or stinging feeling on their skin. The burning sensation occurs even when nothing is touching the affected area. The feeling gets stronger when applying products to the face or when exposed to wind or temperature changes.

• Scaling: The skin develops small, flaky patches that peel away from the surface. The scaling happens as the condition progresses and the skin becomes more irritated. The flakes are small and white or skin-colored.

• Papules: Small, solid bumps that are slightly raised above the skin surface appear in the affected areas. The papules are different from pimples because they do not contain pus. It is in groups and makes the skin feel rough to the touch.

• Skin Tightness: The affected skin feels tight and uncomfortable when making facial expressions. The skin tightness makes smiling or talking feel uncomfortable. The sensation is described as a feeling that the skin is being stretched too thin.

• Clear Border: The rash has a clear, unaffected area right next to the lip line, creating a pattern. The clear border is a feature that helps doctors identify periorificial dermatitis. The space between the lips and the rash is healthy-looking skin.

How does a Rash Around the Mouth and Nose Appear?

A rash around mouth and nose appears as small red bumps and patches that develop around the lips, nostrils, and sometimes near the eyes. The redness around nose shows up as inflamed skin with tiny raised spots that look like small pimples but feel rough and scaly. The same type of bumpy, red rash spreads to the areas around the eyelids, when perioral dermatitis eyes gets involved in the eyes, making the skin look irritated and swollen.

Steroid creams, fluoride toothpaste, heavy moisturizers, and makeup products cause the skin to react and form the bumps. Face masks, sunscreen, birth control pills, and eating spicy foods make the condition worse once it starts. Other triggers include hormonal changes, dental materials, chewing gum, and allergic reactions to skincare products that damage the skin's protective barrier and keep the rash coming back.

Is Perioral Dermatitis Itchy or Painful?

Yes, Perioral Dermatitis is itchy or painful if the burning worsens. Patients are asking, “Is perioral dermatitis itchy”? Patients experience itching as the inflammation increases, while redness, bumps, and dryness characterize the condition. The discomfort intensifies when the skin becomes irritated by external factors (harsh weather or topical products), causing an itchy or burning sensation around the affected areas.

The affected skin becomes more sensitive when perioral dermatitis symptoms worsen, leading to itching and pain. The perioral area occurs due to the buildup of inflammation and the presence of pustules or scaly patches. The skin feels tender, irritated, and sore, contributing to the discomfort and itching, but perioral dermatitis is not as itchy as other skin conditions when flare-ups occur. The severity of the symptoms varies depending on triggers (stress, skincare products, or even hormonal fluctuations). The burning sensation leads to greater discomfort, causing the patients to seek medical treatment. Proper management of the condition, including the use of appropriate medications, helps reduce the intensity of the symptoms.

What are the Treatments for Periorificial Dermatitis?

The treatments for Periorificial Dermatitis are listed below. 

• Topical Antibiotics: Topical antibiotics (metronidazole) are prescribed for periorificial dermatitis. The medications help reduce inflammation and bacterial growth in the affected areas. Metronidazole, applied directly to the skin, treats the condition and provides relief from redness and pustules.

• Oral Antibiotics: Oral antibiotics (doxycycline or minocycline) are used to treat periorificial dermatitis. The antibiotics work by reducing inflammation and targeting bacteria, which are believed to contribute to the condition. Oral antibiotics are recommended when topical treatments fail or if the rash covers a larger area.

• Topical Steroid Discontinuation: Discontinuing the use of topical steroids is essential for managing periorificial dermatitis, as it worsens the condition. Steroid creams trigger a rebound effect. Gradually tapering off steroids under a doctor's supervision prevents deteriorating symptoms.

• Oral Steroids: Oral steroids are used in the short term to control flare-ups of periorificial dermatitis. It is prescribed for severe cases where topical treatments have not been effective. Long-term use of oral steroids is avoided due to the risk of worsening the condition after discontinuation.

• Antifungal Treatments: Antifungal treatments are prescribed if a fungal infection (Candida) is suspected to be contributing to periorificial dermatitis. Topical or oral antifungals (fluconazole) help address fungal imbalances on the skin. The treatments alleviate symptoms when a fungal overgrowth is a factor.

• Laser Therapy: Laser therapy, pulsed dye laser treatments, is used in some cases to reduce the redness and inflammation associated with periorificial dermatitis. The approach targets blood vessels in the skin, reducing the appearance of redness and promoting healing. Laser therapy is used for patients with persistent or severe cases that do not respond to other treatments.

• Topical Calcineurin Inhibitors: Topical calcineurin inhibitors (tacrolimus or pimecrolimus) are alternative treatments for periorificial dermatitis. The medications work by suppressing immune system activity in the affected skin, helping reduce inflammation without the side effects of steroids. The inhibitors are recommended for long-term use in sensitive areas (the mouth and eyes).

• Skin Care Modifications: Modifying skin care routines improves the management of periorificial dermatitis. Using gentle, fragrance-free, and non-comedogenic products helps prevent irritation. Patients are advised to avoid harsh exfoliants, alcohol-based toners, and products with strong fragrances that worsen skin sensitivity.

• Dietary Adjustments: Foods (spicy dishes, alcohol, or hot drinks) trigger periorificial dermatitis flare-ups. Dietary adjustments, including the elimination of known triggers, help manage the condition. Monitoring food intake and avoiding known irritants reduces the frequency and intensity of flare-ups.

• Stress Management: Since stress is a common trigger for periorificial dermatitis, incorporating stress management techniques into daily life helps reduce flare-ups. Practices (meditation, yoga, or regular physical exercise) help lower stress levels and improve skin health. Reducing stress is essential in preventing recurrent episodes of the condition.

How to Prevent Periorificial Dermatitis?

To prevent Periorificial Dermatitis, there are ten steps to follow. 

1. Avoid Harsh Soaps and Detergents. Use mild, fragrance-free soaps and detergents to avoid irritating the skin. Skin care products with harsh chemicals strip the skin of natural oils, leading to dryness and inflammation, which trigger periorificial dermatitis.

2. Moisturize the Skin Regularly. Apply a gentle, non-comedogenic moisturizer to keep the skin hydrated. Proper skin care helps maintain the skin’s natural barrier and prevents dryness, which is a common trigger for periorificial dermatitis.

3. Wear Loose-Fitting, Breathable Fabrics. Choose clothing made of soft, breathable materials to prevent irritation around the affected areas. Tight or non-breathable fabrics trap sweat and heat, leading to inflammation and discomfort in periorificial dermatitis.

4. Avoid Known Allergens or Irritants. Identify and stay away from allergens or irritants that trigger periorificial dermatitis.

5. Use Hypoallergenic Skincare Products. Opt for skin care products labeled as hypoallergenic to reduce the risk of irritation. The products are used to be gentle and free from harsh chemicals or fragrances that cause inflammation or worsen periorificial dermatitis.

6. Keep Skin Clean and Dry. Wash the affected areas gently with lukewarm water, and pat dry with a soft towel. Keeping the skin clean and dry helps prevent bacterial or fungal growth, which increases periorificial.

7. Protect Skin from Extreme Weather Conditions. Shield the skin from extreme temperatures, wind, or excessive sun exposure by using protective clothing or sunscreen. Harsh weather conditions dry out the skin, leading to irritation and flare-ups of periorificial.

8. Manage Stress Levels. Practice stress-reducing activities (yoga, meditation, or deep breathing exercises). Elevated stress worsens the symptoms. Managing stress is essential for long-term prevention.

9. Use Gentle Laundry Detergents. Choose gentle, fragrance-free laundry detergents to prevent irritation from clothing. The chemicals in harsh detergents irritate sensitive skin, increasing periorificial flare-ups.

10. Consult a Dermatologist for Proper Care. Seek professional advice from a dermatologist to receive a treatment plan for managing periorificial. A dermatologist recommends skin care routines and prescribes medications to control the condition effectively.

How Effective is Skin Care for Periorificial Dermatitis?

Skin Care for periorificial dermatitis is effective through the use of gentle, non-irritating products that help manage inflammation and protect the skin’s natural barrier. Proper skin care helps reduce flare-ups by keeping the skin hydrated and avoiding harsh chemicals, fragrances, and irritants. Moisturizers, mild cleansers, and topical treatments prescribed by a dermatologist (metronidazole or tacrolimus) help control symptoms and promote healing of the affected areas.

Skin care involves avoiding triggers (topical steroids, harsh weather, and foods), in addition to maintaining a consistent routine. It plays a role in managing and preventing flare-ups, while skin care alone does not fully resolve periorificial dermatitis. Patients improve their condition with skin care, reduce the frequency of outbreaks, and maintain healthier skin.

What does EraOrganics offer for Periorificial Dermatitis?

Yes, EraOrganics offers the Relief Dermatitis Cream for managing periorificial dermatitis. The product is formulated to soothe and hydrate dry, irritated skin, making it suitable for conditions like periorificial dermatitis. The cream's plant-based ingredients, including aloe vera and manuka honey, aim to reduce inflammation and support the skin's natural healing process.

Regular application assists in easing symptoms associated with the condition. Its moisturizing properties help maintain skin hydration, which is essential in managing periorificial dermatitis. The Relief Dermatitis Cream is used to be gentle on sensitive skin, providing relief without harsh chemicals. The cream helps restore the skin's natural barrier, preventing irritation. Promoting healthier skin helps reduce flare-ups and provides long-lasting comfort. It offers a calming effect on irritated skin, making it suitable for daily use. The formulation is free from artificial fragrances, ensuring that it does not worsen sensitive skin.

How does Cetearyl Alcohol Provide Gentle Moisture for Periorificial Dermatitis Symptoms?

Cetearyl Alcohol provides gentle moisture for periorificial dermatitis symptoms by acting as an emollient that locks in hydration while soothing irritation on sensitive facial areas. Its blend of fatty alcohols creates a protective layer that reduces dryness, supports barrier repair, and gives creams a stable, smooth texture without provoking flare-ups. The Cetearyl Alcohol for Skin helps maintain balance and comfort for periorificial dermatitis care.

Why is Stearyl Alcohol Considered Safe in Products for Periorificial Dermatitis? 

Stearyl Alcohol is considered safe in products for periorificial dermatitis because it is a fatty alcohol that helps to soften skin and support the barrier without triggering irritation. The gentle texture makes formulations more stable while reducing dryness in sensitive areas affected by dermatitis. The Stearyl Alcohol for Skin provides hydration without worsening the periorificial symptoms.

What are the Best Products from EraOrganics for Managing Periorificial Dermatitis?

The best Products from EraOrganics for Managing Periorificial Dermatitis are listed below. 

1. Relief Dermatitis Cream: The plant-based cream is designed to alleviate symptoms associated with skin conditions, including periorificial dermatitis. It helps to soothe and hydrate dry, irritated skin, reducing redness and inflammation. The Cream from Era Organics includes ingredients (aloe vera and manuka honey), which are known for their healing properties.

2. Original Relief Cream: An extra-strength moisturizer that provides relief for dry, itchy skin. It is enriched with vitamins, minerals, and amino acids to nourish and repair the skin deeply. The Cream is suitable for patients with sensitive skin and aims to restore the skin's natural barrier.

3. Elixir+ Anti-Itch Cream: A 16-in-1 anti-itch cream formulated to address various skin irritations. It combines multiple soothing ingredients to provide quick relief from itching and discomfort. The Cream is designed to be gentle on the skin while effectively combating irritation.

1. Relief Dermatitis Cream

Relief Dermatitis Cream is a plant-based moisturizer formulated to soothe and hydrate dry, irritated skin. The Relief Cream is used to provide relief from skin conditions, including eczema, psoriasis, rashes, hives, and dermatitis. The cream uses natural ingredients known for their skin-healing properties. The formula includes colloidal oatmeal, which has been used for thousands of years to relieve itchy, damaged skin. Aloe vera provides deep hydration and calms irritated skin, while manuka honey nourishes and protects. 

2. Original Relief Cream

The Original Relief Cream from EraOrganics is a 15-in-1, extra-strength moisturizer formulated to alleviate dry, itchy skin associated with conditions such as eczema, psoriasis, rashes, hives, and dermatitis. The plant-based cream combines vitamins, minerals, and amino acids to provide deep hydration and support skin healing.

3. Elixir+ Anti-Itch Cream

The Elixir+ Anti-Itch Cream from EraOrganics is a 16-in-1, plant-based moisturizer formulated to soothe and hydrate dry, irritated skin. The cream combines powerful botanical ingredients to provide relief from itching and inflammation, which is used for conditions (eczema, psoriasis, dermatitis, rashes, and hives).

Can Cetyl Alcohol Help Support the Barrier in Periorificial Dermatitis Care?

Yes, Cetyl Alcohol can help support the barrier in periorificial dermatitis care by providing emollient properties that moisturize and protect against dryness. The effect strengthens the skin’s outer layer, reducing irritation while giving formulations a smooth, stable base. The Cetyl Alcohol for Skin plays a key role in maintaining comfort and barrier integrity.

Disclaimer: This content is for informational purposes only and is not intended as medical advice. Always consult with a healthcare professional before starting any new skincare routine or supplement. These statements have not been evaluated by the Food and Drug Administration.