If you’re having a rosacea flare-up and think things can’t get any worse, just know they can! It’s called perioral dermatitis and it is a beast to deal with. It often starts with one giant pimple for me. Eventually it expands in the area until I have a complete beard of large pimples. It’a a real downer. The skin surrounding the acne is often inflamed like rosacea and also with dry, flaky skin.
What is Perioral Dermatitis?
This stubborn skin condition, perioral dermatitis, is a facial rash that usually shows up around the mouth, chin, nose, and sometimes the eyes. It looks like red or pink bumps, sometimes with mild peeling, burning, or itching. In some cases, the bumps are filled with fluid and can resemble acne, but using acne treatments often makes it worse.
Despite the name, it’s not true dermatitis (like eczema), nor is it acne. It’s somewhere in between and a form of inflammatory skin condition. The appearance can vary from person to person, but it generally makes skin look irritated and inflamed, especially around the mouth area.
What Causes Perioral Dermatitis?
Here’s the tricky part: the exact cause isn’t known, but most cases are believed to be caused by a combination of factors rather than just one thing.
Here are the most common culprits:
1. Topical Steroids
Many people develop perioral dermatitis after using topical corticosteroids, either prescribed for eczema, or over-the-counter hydrocortisone creams. These creams might initially reduce redness, but once you stop using them, the rash often comes back worse. It’s a cycle.
2. Skincare Products and Cosmetics
Heavy creams, oily moisturizers, and even “natural” products can clog pores and irritate the skin. Some ingredients can trigger or worsen perioral dermatitis, especially when used around the mouth and nose.
3. Toothpaste
Fluoride and sodium lauryl sulfate (SLS), a foaming agent found in many toothpastes, can irritate the skin and contribute to perioral dermatitis in sensitive individuals.
4. Hormonal Changes
Apparently hormones can play a role, especially in women between ages 20–45, who are the most commonly affected. Fluctuations due to birth control or menstrual cycles can be contributing factors.
5. Environmental Factors
Heat, wind, and even wearing masks for long periods (think moisture and friction) can aggravate the area and promote flare-ups.
Is Perioral Dermatitis Similar to Rosacea?
You can definitely just get perioral dermatitis and not get rosacea. In fact, many people who get perioral dermatitis have no other chronic skin conditions. It often occurs as a stand-alone issue, usually as a reaction to something topical discussed above.
That said, people with rosacea-prone skin may be more susceptible, so it’s not unusual to see some overlap.
Perioral dermatitis is an inflammatory skin condition. That means the skin is reacting, sometimes excessively, to a perceived irritant or imbalance.
This inflammation can be driven by:
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Skin barrier disruption (from over-washing, scrubbing, or using too many products)
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Immune system responses
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Hormonal triggers
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Gut-skin axis imbalance
While the trigger might be external, the body’s inflammatory response is what keeps the rash going.
What Kind of Skincare Can Cause Perioral Dermatitis?
Unfortunately, many everyday products can be irritating, especially if you have sensitive skin. Here are some common ingredients linked to perioral dermatitis:
Harsh or Heavy Ingredients:
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Petroleum or mineral oil (in thick creams and ointments)
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Silicones (like dimethicone)
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Lanolin (often in moisturizers)
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Fragrance or essential oils (even natural ones can be irritating)
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Alcohol-based toners or astringents
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Chemical sunscreens (such as oxybenzone)
Detergents and Surfactants:
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Sodium lauryl sulfate (SLS) – a common foaming agent in cleansers and toothpaste
Even “natural” or “organic” skincare products can cause problems, and some essential oils like peppermint, tea tree, lavender, or citrus extracts have been flagged as possible irritants.
Korean Skincare Caused My Perioral Dermatitis
I have had perioral dermatitis in the past and always at the same time as major rosacea flare-ups. It’s apparent now that I was more susceptible to perioral dermatitis since I was already in a state of high inflammation.
I was hesitant to try new skincare but I was desperate because of my extremely dry, flaky skin. Nothing was helping me, so after reading a million reddit posts from the rosacea subreddit, I decided to try Korean skincare. They seemed to have relatively clean ingredients and had supposedly helped a lot of people tame their rosacea flare-up. I decided to try some Korean skincare which I thought had relatively clean ingredients, and nothing that typically was said to cause perioral dermatitis. But boy was I wrong.
But Didn’t You Do a Patch Test?
I tried! I put it on my jawline and beside my ear and all the places people say to try it out and everything seemed fine. But no, major pimples formed on my chin and I knew I was screwed.
After finding another lone reddit post on the topic, turns out that chemicals called propylene glycol and butylene glycol were also a no-no when you have rosacea. These are commonly found in skincare, not just particularly in Korean ones. Apparently they are both considered safe UNLESS you have sensitive skin. Sigh. Here I thought finally, products that don’t have hyaluronic acid and niacinamide, both which irritate my skin. I didn’t realize my list was about to get much bigger.
How I Resolved My Perioral Dermatitis
In the past, my perioral dermatitis was only ever resolved with doxycycline. But with a year long wait to see a dermatologist, I had to figure out how to do this on my own without medication. Here are the three things that helped:
1. Zero Therapy
Yes, my skin was dry AF. But I knew I needed to back away from skincare as much as I could for now, so zero therapy, or the caveman regimen was the route to go. And boy is it hard to do nothing. You want to try everything you can to tackle the problem. Looking in the mirror is crazy depressing, and so is going out without make-up and anything else that will kind of camouflage the skin. But when your skin is already inflamed, anything else you add to it will become an irritant.
On another note, as much as you want to squeeze the shit out of a zit that has some pus in it, don’t do it! Speaking from experience y’all! Not perioral dermatitis, but I did this to a huge pimple on my forehead – near inner corner of my eyebrow. Doing that apparently spread the infection and my forehead to this day has never been the same. Please resist the urge to touch these pimples. It’s not worth the consequences!
2. Diet
This is a topic I will cover extensively in a few posts, but basically I knew I had to reduce the inflammation in my body and the only way to do this now would be to completely change my diet. I realized at this point that I had a leaky gut.
3. Sulfur Treatment
I had purchased a sulfur soap with 10% sulfur that seemed promising. It also contained olive oil, coconut oil, cocoa butter, shea butter and castor oil, so I thought great, this will be moisturizing for my skin as well.
Nope, totally wrong. Instead it was incredibly drying and did nothing for my rosacea or perioral dermatitis. I put off trying any more sulfur treatments because I thought, if a treatment with a high percentage of sulfur which included oils made me dry out, how will a more pure sulfur be any better?
Eventually out of desperation I gave in and tried a much discussed sulfur treatment on reddit called De La Cruz ointment.
(This is an amazon link where I earn a small commission but only recommend products that worked for me.)
Start off slow, just a few minutes at a time and extend up until 10 minutes. You can push to 15 minutes but I wouldn’t do more than that. Some reddit posters said they put it on overnight, but that isn’t a risk I’m willing to take. The best part is that it isn’t expensive, and yes we are sick of dumping money on useless products.
Within a month I noticed a big difference. Many of the large zits had flattened out. Perioral dermatitis is extremely stubborn and can take many weeks to resolve. This little jar was definitely worth the investment.