Redness, small pimples, a feeling of tightness – all right in the middle of your face: Perioral dermatitis, also known as perioral dermatitis, is a common but often misunderstood skin condition that primarily affects women. It typically occurs around the mouth and isn't caused by poor hygiene, but usually the opposite – by over-care. In this article, you'll learn how to recognize perioral dermatitis, what causes it, why the skin microbiome plays a key role, and how to restore balance to your skin – without aggressive products, but with patience, understanding, and the right strategy.
What is perioral dermatitis?
Perioral dermatitis – also known colloquially as perioral dermatitis – is an inflammatory skin disease that primarily occurs on the face. It is characterized by red, itchy, or burning pustules around the mouth, and occasionally around the nose and eyes. The disease predominantly affects women between the ages of 20 and 40, but men and even children can also be affected.
The term "perioral" means "around the mouth," and "dermatitis" refers to an inflammation of the skin. It typically presents with a small, narrow strip of skin directly around the lips that remains free of rashes—an important distinguishing feature from other skin diseases such as acne or rosacea.
What does perioral dermatitis look like?
The skin changes appear in various forms, often in combination:
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Redness and flaking of the skin around the mouth
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Small, inflamed papules or pustules (not blackheads like in acne!)
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Feeling of tension, burning, itching
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Dry, irritated skin
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Less common: Involvement of the skin around the nose or the eye area (this is then also referred to as “periorbital” or “perinasal” dermatitis)
The rash usually develops gradually, often after a period of intensive skin care or the use of new cosmetic products. Symptoms can persist for weeks to months and are prone to relapse.
Causes: Why does perioral dermatitis occur?
The exact cause is not fully understood, but there are several contributing factors :
1. Over-care of the skin (overuse of cosmetics)
A key trigger is the excessive use of cosmetics—especially rich creams, high-coverage makeup, or so-called "anti-aging" products. These can overwhelm the natural skin barrier and disrupt the balance of the skin's flora.
2. Creams containing cortisone
Many sufferers initially use cortisone-containing ointments to treat the rash, but this often worsens the skin's condition in the long run. Although cortisone suppresses inflammation in the short term, it causes a rebound effect in perioral dermatitis once use is discontinued.
3. Toothpaste with fluoride or harsh mouthwashes
Some people are sensitive to certain ingredients in toothpaste, such as fluoride, foaming agents, or menthol. These can irritate sensitive skin and trigger a flare-up.
4. Hormonal fluctuations
As with many skin diseases, hormonal changes play a role – for example in connection with the menstrual cycle, the use of hormonal contraceptives or during pregnancy.
5. Stress and lifestyle
Psychological stress, lack of sleep, poor diet and nicotine can worsen the skin condition or trigger an attack.
6. Climate and UV radiation
Strong sunlight or dry heating air can further irritate the skin.
The role of the skin microbiome in perioral dermatitis
An increasingly important factor in skin health is the microbiome —the entirety of microorganisms that live on our skin. This natural ecosystem consists of bacteria, fungi, and other microbes that exist in a delicate balance. In healthy skin, the microbiome protects against harmful germs, regulates inflammation, and supports the skin's barrier function.
In perioral dermatitis, this balance is often disrupted—a condition known as dysbiosis . Overuse of cosmetics, harsh cleansers, or the use of cortisone creams can cause lasting damage to the microbiome. This makes the skin more susceptible to inflammation, which can promote or worsen the typical rash.
Gentle, minimalist skincare not only helps the skin barrier but also gives the microbiome a chance to regenerate. Some modern skincare products even contain prebiotic or probiotic ingredients that specifically promote good skin bacteria. These can be supportive during the further course of treatment – after consulting a dermatologist.
Who is affected?
Most commonly affected are:
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Women between 20 and 40 years
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People with sensitive or dry skin
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Cosmetics lovers with a distinctive skincare routine
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People with a history of skin diseases such as atopic dermatitis or rosacea
Babies and toddlers can also develop perioral dermatitis – usually due to excessive salivation in combination with incorrect care or irritation from bibs, pacifiers, etc.
Diagnosis: How is perioral dermatitis diagnosed?
The diagnosis is usually made clinically—that is, by visual examination by a dermatologist. Typical features include the symmetrical arrangement of the pustules around the mouth and the absence of blackheads.
In unclear cases or in severe cases, a skin sample (biopsy) may be taken to rule out other diseases such as acne, rosacea or fungal infections.
Treatment: What helps against perioral dermatitis?
The most important measure is: Stop care!
1. Zero therapy – less is more
Your skin needs rest. This means avoiding all cosmetics, creams, serums, and makeup , even if it's difficult. Only lukewarm water or mild, pH-neutral cleansing products are permitted. This abstinence may initially lead to a short-term worsening ("withdrawal symptoms"), but afterward, your skin usually improves significantly.
2. Discontinuation of cortisone
If you have previously used cortisone creams, they should be tapered off slowly and discontinued under dermatological supervision – abrupt discontinuation can lead to a severe relapse.
3. Topical medications (local therapy)
The dermatologist may prescribe certain creams or gels, such as:
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Metronidazole (anti-inflammatory, antibacterial)
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Erythromycin or clindamycin (antibiotics)
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Azelaic acid (soothing and anti-inflammatory)
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Pimecrolimus or tacrolimus (for particularly sensitive skin)
4. Antibiotics (in severe cases)
In severe or chronic cases, systemic treatment with antibiotics such as doxycycline or minocycline may be necessary for several weeks, even if there is no bacterial infection. These medications have anti-inflammatory effects and regulate the skin flora.
What you can do yourself – everyday tips
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Avoid greasy or heavily perfumed cosmetics.
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Use toothpaste without fluoride or irritating additives.
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Wash your face only with water or a very mild cleansing gel.
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Keep your hands off your face! Rubbing, pressing, or scratching will only worsen the inflammation.
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Avoid wearing makeup , especially during the acute phase.
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Pay attention to your diet. Sugar, white flour, alcohol, and highly processed foods can promote inflammation.
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Reduce stress. Yoga, meditation, or walking not only help your soul, but also your skin.
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Sun protection: Even if creams are taboo, a light mineral sunscreen (e.g. zinc oxide-based) is useful in cases of strong UV exposure.
How long does the healing take?
The healing time depends largely on the severity and the discipline of treatment. In mild cases, the skin condition improves after just two to three weeks of no-therapy. In more severe cases—especially after cortisone abuse—it can take up to three months for the skin to fully regenerate.
Important: Even after symptoms subside, the skin is prone to relapse if excessive use of cosmetics is resumed. A gentle, minimalist skincare routine is recommended in the long term.
Conclusion: Healing through withdrawal
Perioral dermatitis is a distressing but treatable skin condition. The key to improvement lies not in more care, but in less. The skin must learn to regulate itself – without constant external stimuli.
With patience, consistency, and conscious skin care, you can successfully control the symptoms – and give your skin peace and balance in the long term.
