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Rash around the mouth … what is that?

August 26, 2019 / Duncan Fisher
‘Perioral dermatitis’ probably. It’s treatable.

One of the common questions our dermatologists get, here at Snapmed, is what to do about pink and irritated skin that sometimes appears around the mouth. More often than not, the mouth belongs to a child, or a youngish woman. The irritated area can have scaly patches, or inflammatory papules and pustules, like acne. Once in a while it extends around the nose, and very occasionally up to an eye.

There are many conditions that can cause eruptions that look like this. One is rosacea. (We wrote about that just recently.) Another is acne ‘vulgaris’. Others are sarcoidosis, contact allergy, irritant ‘cheilitis’ (the children’s lip-licking rash), demodex mites, tinea infection, or, rarely, skin tumors like syringomas. There are tests we can recommend to check for these.

Very often, though, it’s none of them. It’s just inflamed skin around the mouth. Its cause isn’t clear, but it’s probably environmental, with contributions from genes and hormones. It’s nothing dangerous. And in general it’s quite treatable. We name it simply by the descriptive expression, ‘perioral dermatitis’.

‘Peri-‘ means ‘around’. ‘Oral’ refers to the mouth. ‘Derm-‘ refers to skin. ‘-itis’ denotes inflammation.

Most perioral dermatitis is diagnosable on sight. Skin biopsies and other investigations aren’t usually warranted.

First-line treatment options include creams or gels. You can ask your doctor about metronidazole, clindamycin, erythromycin, topical sulphur preparations, or azelaic acid. Sometimes antibiotics are prescribed along with these – not because there’s any infection to treat, but because antibiotics sometimes have anti-inflammatory properties. You can also ask about topical ‘calcineurin inhibitors’, such as tacrolimus ointment or pimecrolimus cream.

If you’ve been using topical steroids, like cortisone cream, thinking you’re treating eczema, you may have made things worse without meaning to. Be sure to tell your doctor if you’ve been self-treating with anything, particularly if it’s a steroid preparation.

Perioral dermatitis can be a long-term condition. Topical therapies may not show peak efficacy for two or three months. Relapses are common as well.

To say it again, though, it is quite treatable, and though it’s irksome, it’s nothing dangerous. We're happy to have a look for you.

Questions about your skin? Ask our dermatologists online for $35.