It often starts innocuously: a small cluster of spots around the mouth, easily dismissed as a hormonal breakout or a reaction to something you have eaten. But this is how perioral dermatitis shows up \u2013 quietly, persistently and seemingly more frequently.<\/p>\n
The Guardian\u2019s journalism is independent. We will earn a commission if you buy something through an affiliate link.\u00a0Learn more<\/a>.<\/p>\n \u201cIt\u2019s quickly become one of the most common inflammatory conditions I treat,\u201d says Dr Anjali Mahto, a consultant dermatologist and founder of the Self London clinic. Reddit threads on the subject run to thousands of posts, TikTok is awash with people documenting flare-ups, and actor Amanda Seyfried has spoken publicly<\/a> about dealing with it. A recent report<\/a> in the Journal of the American Academy of Dermatology confirmed the condition is on the rise. Meanwhile, the global market<\/a> for perioral dermatitis treatments is growing.<\/p>\n I realised it is becoming increasingly common the slow way. What I assumed was a fleeting breakout lingered for weeks, resisting every serum, cream and mask I threw at it. In trying to fix it, I made it worse \u2013 layering on actives and, in a moment of panic, even reaching for a steroid cream better suited to eczema. It wasn\u2019t until I started speaking to experts for this article that the penny dropped: the condition I was researching was the thing I\u2019d been dealing with.<\/p>\n What is perioral dermatitis?<\/strong><\/p>\n Perioral dermatitis is a chronic inflammatory skin condition that typically appears as clusters of small red bumps (hard papules or pimple-like pustules) around the mouth, nose and eyes. Anyone with dark skin <\/a>may find that the patches look darker than their normal skin colour, rather than red. \u201cThe area around the mouth is particularly vulnerable, because the skin there is thinner and exposed to constant friction and moisture from speaking, eating, cleansing and applying skincare. It is also a zone where products such as moisturiser, SPF, makeup or toothpaste can easily migrate and accumulate,\u201d says aesthetic medicine specialist Dr Christine Hall.<\/p>\n Perioral dermatitis usually appears as red bumps around the mouth, nose and eyes. Photograph: Olga Shefer\/Getty Images<\/p>\n At first glance, perioral dermatitis can resemble acne \u2013 which is why it\u2019s often misdiagnosed. \u201cAcne usually involves blocked pores, blackheads and excess oil,\u201d says Hall, \u201cwhereas perioral dermatitis appears without blackheads and is more likely to cause burning, tightness, dryness or sensitivity rather than deep, painful spots.\u201d The bad news? Once the skin\u2019s outermost layer, or barrier, in this area becomes compromised, inflammation can develop and cause repeated flare-ups if the triggers are not addressed.<\/p>\n W<\/strong>hat\u2019s behind the surge?<\/strong><\/p>\n One explanation comes up again and again: we are using way too much skincare. In the quest for \u201cperfect skin\u201d, many of us are throwing everything at our faces and hoping for the best. The problem is that modern products are often far more active \u2013 containing clinically proven compounds designed to target specific concerns \u2013 than people realise. Your daily serum likely has a combination of potent antioxidants. Your night-time retinol speeds up cell turnover. Your cleanser may contain exfoliating enzymes. A daily toner may contain acids. All of this can push the skin barrier past its limit. \u201cThe rise in perioral dermatitis cases is largely driven by these complex routines using highly concentrated actives,\u201d says Mahto.<\/p>\n Part of the issue with finding the cause is that the reaction to products is not always immediate. With active ingredients such as retinal (a form of vitamin A), there\u2019s often a cumulative effect: your skin barrier can be slowly weakened over weeks or months before it tips into visible inflammation.<\/p>\n Another cause you may not expect: clean beauty. This is the case for Charlotte Palermino, writer and co-founder of skincare brand Dieux Skin. \u201cWhen I was 25, I thought all my products were toxic. I started using natural products and the natural fragrances made my skin freak out. I was told my skin was \u2018purging\u2019, but really I had a horrific perioral dermatitis rash.\u201d Eventually, Palermino\u2019s friend\u2019s mother, a dermatologist, pulled her aside to offer some advice: \u201cAs gently as she could put it, she asked if I was in pain \u2013 I was. She wrote me a prescription for topical antibiotics, and it was the combination of topical antibiotics and sulphur that really got rid of it. Now, whenever I have a flare-up, I use the combo and it calms down. My triggers are now excessive skincare, \u2018skin flooding\u2019 <\/a>or lavender oil.\u201d Palermino\u2019s isn\u2019t an isolated case; Dr Emma Craythorne, consultant dermatologist and chief medical officer at the skincare brand Klira<\/a>, explains why clean beauty regimes often cause problems. \u201cFor years, we used parabens in skincare and understood how they behaved. But as they were pushed out by \u2018clean beauty\u2019, newer preservatives replaced them and we\u2019re less certain how these interact with the skin. Some theories suggest they may disrupt the microbiome and contribute to conditions like perioral dermatitis.\u201d<\/p>\n Illustration: Lisa Sheehan\/The GuardianAre there <\/strong>any other factors at play?<\/strong><\/p>\n \u201cSteroids can also play a role in perioral dermatitis, particularly topical steroids used for eczema, and inhaled steroids for asthma,\u201d says Craythorne. If you use an inhaler, she advises rinsing your mouth afterwards, and if you apply steroid creams to your body, wash your hands before touching your face. Hormones can play a role, too. \u201cIt can worsen in people with hormonal imbalances \u2013 for example, those taking medication for PCOS [polycystic ovary syndrome] or undergoing IVF or egg collection.\u201d<\/p>\n Surprisingly, toothpaste is also a common culprit. Ingredients such as sodium lauryl sulfate (SLS), the foaming agent in many formulas, plus \u201cstrong flavourings such as mint or cinnamon oils, as well as alcohol-based mouthwashes, may also irritate sensitive skin,\u201d says Dr Alex Seijas, founder of The London Orthodontic Clinic. \u201cDespite common concerns, fluoride is rarely the cause.\u201d Braces or aligners can subtly change how the lips sit against the teeth, increasing saliva contact, lip licking or friction around the mouth \u2013 all of which can irritate sensitive skin. And because people with orthodontic appliances tend to brush more frequently, this means that the skin is exposed to toothpaste ingredients more often.<\/p>\n The solution is usually simple: keep brushing, but switch to a gentler, SLS-free toothpaste, rinse the skin around the lips after brushing, and don\u2019t let foam sit on the skin. A smart tip from Hall: brush your teeth before cleansing your face so toothpaste residue isn\u2019t left sitting on already irritated skin.<\/p>\n How do you get rid of it?<\/strong><\/p>\n Here\u2019s the part skincare-lovers like me often struggle with: doing less may be the solution. \u201cI advise stopping all facial cosmetics and topical products \u2013 even sunscreen \u2013 for a short time, and switching to a very mild cleanser and a bland emollient,\u201d says Craythorne. \u201cLight gels or liquids are better than heavy creams.\u201d In practice, that means using oil-free, fragrance-free gel cleansers and simple, lightweight lotions while the skin barrier recovers.<\/p>\n The next step? \u201cOnce the barrier settles and the inflammation, redness and bumps reduce, we can slowly introduce gentle, anti-inflammatory ingredients like azelaic acid,\u201d Mahto says. Azelaic acid may sound counterintuitive after all the advice to stop actives but, once the skin barrier has recovered, its gentle anti-inflammatory and antibacterial properties can reduce redness and spots. Other ingredients can be slowly introduced at this stage. Dr Hall recommends barrier-supporting hydrators such as ceramides, panthenol, centella asiatica (also known as cica cream<\/a>), glycerine and hyaluronic acid to soothe inflammation and restore moisture. But you\u2019ll need to wait until your skin is fully healed before reintroducing anything like retinal, tretinoin or acids.<\/p>\n In more stubborn cases, doctors may prescribe a short course of an oral antibiotic such as doxycycline to help reduce inflammation. Nonsteroidal topical treatments such as Protopic may also be prescribed \u2013 which, in my case, is what finally cleared things up.<\/p>\n Some supportive technologies may also help calm inflammation, but the timing matters. \u201cOnce the condition has been recognised and the inflammation is medically controlled, very gentle clinical treatments like LED can support healing because they\u2019re calming and non-irritating,\u201d says aesthetic doctor Paris Acharya. What should we avoid during the active and healing periods? \u201cAggressive facials, peels, microneedling or any heat-based treatments. Perioral dermatitis is one of those conditions where doing more is usually the wrong instinct.\u201d<\/p>\n As for lingering marks, patience is key. \u201cSome patients are left with redness, pigmentation or slight texture changes,\u201d Acharya says. \u201cOnce the dermatitis has fully settled, these can be treated effectively \u2013 but timing is everything. Treat too early and you risk reactivating the whole process.\u201d<\/p>\n Prevention is the way forward<\/strong><\/p>\n Every expert I spoke to said that perioral dermatitis is, in many ways, a symptom of the modern beauty culture. We\u2019ve never had more products, more online advice or more pressure to perfect our skin \u2013 yet sometimes the most radical thing is to do less. \u201cOne of the most important lessons perioral dermatitis teaches us is that healthy skin relies on balance,\u201d says Hall. \u201cWhen we overwhelm the skin with too many products or powerful actives, inflammation will follow.\u201d<\/p>\n The crucial shift to make is in how we use products: use lower strengths less frequently, and avoid layering multiple actives at once. For many, it\u2019s not the ingredient itself that\u2019s the issue, but the cumulative overload of irritation.<\/p>\n It is also important to think about whose advice you follow. Skincare<\/a> influencers often promote lengthy routines and multiple products, but experts urge caution. \u201cTrust people who preach simplicity,\u201d says Palermino. \u201cOvercomplication can feel nice, but it can also mess up your face. Boring skincare advice tends to be the most sage and results-driven.\u201d<\/p>\n Illustration: Lisa Sheehan\/The GuardianSoothe your skin: Anita\u2019s pick of products that can help<\/strong><\/p>\n La Roche-Posay Toleriane Dermo-Cleanser<\/a>, \u00a316.50<\/strong> Av\u00e8ne Tol<\/a><\/strong>erance Hydra-10 <\/a><\/strong>Hydrating Fluid<\/a>, \u00a321<\/strong> The Ordinary Azelaic Acid Suspension 10%<\/a>, \u00a311.10<\/strong> Dr Jart+ Cicapair Tiger Grass Camo Drops SPF 35<\/a>, \u00a337.50<\/strong> Saie Slip Tint Radiant All-Over Concealer<\/a>, \u00a324<\/strong> Gutology <\/a><\/strong>Mineral Toothpaste<\/a>, \u00a316<\/strong>
This gentle, non-foaming cleanser is designed for sensitised skin and cleanses without disrupting or stripping the delicate barrier.<\/p>\n
My go-to for any kind of skin flare-up is this pared-back moisturiser designed for hypersensitive skin. Hyaluronic acid hydrates and thermal spring water helps to soothe irritation. It\u2019s fragrance-free and lightweight.<\/p>\n
Once the skin is fully healed, this gentle treatment can help to reduce redness and calm inflammation.<\/p>\n
Centella asiatica (AKA cica or tiger grass) can help soothe redness thanks to its anti-inflammatory, healing properties. These lightweight drops offer a sheer hint of coverage and SPF \u2013 a breathable alternative to heavy foundation while skin recovers.<\/p>\n
When perioral dermatitis is settling, a hydrating concealer can give light coverage without clogging or irritating the skin. This formula contains glycerine and hyaluronic acid to help draw moisture into the skin, keeping the area comfortable rather than dry or tight.<\/p>\n
Gentle, SLS-free and supportive of the oral microbiome, this toothpaste delivers a clean, fresh feel without harsh additives.<\/p>\n