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Perioral Dermatitis

By Karen McKoy, MD, MPH, Assistant Clinical Professor, Dermatology;Senior Staff, Harvard Medical School;Lahey Clinic Dermatology

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Perioral dermatitis is a red, bumpy rash around the mouth and on the chin that resembles acne, rosacea, or both.

Although the exact cause is unknown, exposure to corticosteroids that are applied to the skin, use of water or toothpaste that has fluoride in it, or both have been proposed as possible causes. The disorder mainly affects children and women of childbearing age. The rash typically starts in the folds of skin on the sides of the nose (nasolabial folds) and spreads around the mouth (the perioral area). The rash can also spread around the eyes and to the forehead.

Perioral dermatitis is distinguished from acne by the lack of blackheads and whiteheads (comedones). Perioral dermatitis can be hard to distinguish from rosacea. However, rosacea does not cause a rash to form around the mouth. Other symptoms of rosacea must be present for that diagnosis to be made instead of perioral dermatitis. Doctors also rule out other types of dermatitis such as seborrheic dermatitis and contact dermatitis.

People with perioral dermatitis should stop using toothpaste with fluoride and corticosteroids that are applied to the skin. Doctors give antibiotic creams or gels or tetracyclines or other antibiotics taken by mouth. Antibiotics can be stopped once the rash goes away. If these antibiotics do not clear up the rash and the disorder is particularly severe, isotretinoin, an acne drug, may help. Corticosteroids and some oily cosmetics, especially moisturizers, tend to worsen the disorder.

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