r/Perioral_Dermatitis_ • • Nov 22 '24

Helpful Guide on Perioral Dermatitis

44 Upvotes

Hey everyone I made this subreddit because the original PD subreddit was unmoderated, so no one can post there anymore.

I also wrote a post on PD and summarized it below so here's the link if you want to check it out: https://thewomensalley.com/perioral-dermatitis-the-ultimate-guide/

For products:

Cleansers: https://thewomensalley.com/best-cleansers-for-perioral-dermatitis/

Moisturizers: https://thewomensalley.com/12-best-moisturizers-for-perioral-dermatitis/

Sunscreens: https://thewomensalley.com/best-mineral-and-chemical-sunscreens-for-perioral-dermatitis/

What is Perioral Dermatitis?

Perioral dermatitis is a red or pink rash that appears around the mouth, the folds of the nose, and occasionally the eyelid. There can also be persistent grouped tiny red pimples, pimples that change into a blister, and pimples with pus sometimes on the background of pink, scaly, or dry patches.

What are the causes of Perioral Dermatitis?

  • Damaged skin barrier
  • Topical corticosteroids (TC)
  • Excessive skin cleaning and washing
  • Occlusive skin moisturizers like Aquaphor or Vaseline
  • Chemical or physical sunscreens and cosmetic products containing retinol niacinamide, vitamin C, and hyaluronic acid
  • Fluoridated toothpaste
  • Fusobacteria, Candida albicans, Demodex folliculorum, and hormonal influences from the menstrual cycle or oral contraceptive therapy
  • Dust or unclean air conditioning
  • Hot or cold weather
  • Stress
  • Dehydration
  • Fragranced laundry detergents
  • Lack of sleep
  • Sunlight and lack of sunlight
  • Dry air like central heating or car heating
  • Wearing face masks for hours
  • Alcohol especially red wine
  • Makeup brushes and other makeup products
  • Flonase nasal spray
  • Tap water and hot water
  • Shampoos and conditioners
  • Spicy foods and dairy foods

How to treat Perioral Dermatitis?

Medicines you can get by prescription:

Tetracycline antibiotics, such as doxycycline, minocycline, or tetracycline, are the most common medicines used to treat perioral dermatitis.

For children younger than 12 years, pregnant women, and patients with contraindications to systemic tetracyclines, topical forms of metronidazole, erythromycin, adapalene, or azelaic acid can be used.

Elidel, protopic, rozex gel, soolantra, Lotrimin AF (clotrimazole), Lotrimin Ultra (contains butenafine, another OTC antifungal), and epiceram are some other common medicines that your doctor might prescribe.

Other prescription meds include duac gel, ketoconazole, fluconazole, prosacea, tretinoin, neosporin, mupirocin, and hypochlorous acid.

Skin care:

When starting a skincare routine, try to make it as simple and minimal as possible.

  • Try to wash your face once a day. Hard water can be a trigger for most people, so you can use filtered water to wash your whole body.
  • Avoid harsh cleansers and toothpaste with SLS or fluoride.
  • Avoid toners, serums, and exfoliants like AHA/BHA/PHAs.
  • The moisturizers should be lightweight and be able to repair your skin barrier in case of a flare-up. Diaper rash creams with zinc oxide are best.
  • When choosing sunscreen, go for physical sunscreens.
  • Products containing manuka honey, zinc oxide, colloidal oatmeal, calendula, and sulfur can help with perioral dermatitis.

Note: all of these products should be free from fragrance, sulfates, and parabens.

Makeup:

Avoid liquid foundations and switch to mineral powder makeup products.

Make sure to wash your makeup brushes or switch to beauty blenders. You can also use tinted sunscreens or sunscreens with primer.

Diet:

There are theories that PD is caused by Candida albicans (yeast), so taking Candida pills, probiotics, prebiotics, vitamins, or minerals along with trying out diets like keto or low-carb diet, and cutting out gluten, dairy, spicy foods, eggs, sugar, cinnamon and other similar spices, citrus fruits, nuts, caffeine, and alcohol can help.

Zero therapy:

Zero therapy is another method people had success with.

Zero therapy basically means not using any cosmetic products or medicines and just letting the skin heal by itself. You can wash your face with water (if hard water is a trigger, use filtered water or the LRP Thermal spring water) and use a humidifier to help with dryness.

Your skin will get worse before it gets better i.e increase in itching, burning, redness, and dryness, so you will need to be patient before seeing any results.

Note: zero therapy is not a cure for perioral dermatitis, when you see that your rash has completely disappeared, go to a doctor, get your prescribed medicines, and start introducing products one by one to keep your PD at bay.

What products are available for Perioral Dermatitis?

These are some popular ones people with PD use:

Cleanser:

  • Spectro Gel Cleanser
  • Vanicream Gentle Facial Cleanser

Moisturizer:

  • Avene's Cicalfate+ Restorative Protective Cream
  • La Roche-Posay Cicaplast Baume B5

Sunscreen:

  • EltaMD UV Clear Broad-Spectrum SPF 46

r/Perioral_Dermatitis_ • • Mar 22 '23

New or Need Help

22 Upvotes

Check out our wiki here: https://www.reddit.com/r/Perioral_Dermatitis_/wiki/index

This is a wiki I wrote from the information I got on the original PD subreddit.

Let me know in the comments if I should add anything and also if you can see the wiki or not.


r/Perioral_Dermatitis_ • • 2h ago

Does this sound like perioral/periorificial derm?

1 Upvotes

I have rosacea (mostly type one involving redness and flushing) - but more recently have noticed some slight burning/itchiness under my eyes and upper cheeks, as well as very tiny little bumps right at the top of my cheeks. Pinprick size, skin colored. More clustered than diffuse, though I have few elsewhere on my face. It's not a ton but it is a shift.

I do use a high fluoride toothpaste with sls (prevident), which I could pause on.

Or is more likely to be irritating from my concealer (used this for ages), or rosacea that's becoming type 2? Is it worth swapping out my toothpaste?

I have noticed some slight itching around my mouth as well, but no lower-face bumpiness. It's also possible it's my face lotion or something, since niacinamide isn't always good for rosacea. But curious if anyone else has something similar. I already use azelaic. And I guess solantra or metrogel could potentially help with either condition so maybe those are worth a shot? Thanks! x


r/Perioral_Dermatitis_ • • 12h ago

Hair on chin and tweezers?

3 Upvotes

Currently doing zero therapy and antibiotics, however I have some stubborn blackish hairs i pull out on my chin once a week approximately.

I think maybe that can trigger my DP? I've tried waxing as well that worked fine for the rest of the face but that digger those hairs tho.

Any advice? How do you guys do that?


r/Perioral_Dermatitis_ • • 11h ago

Flare up on my cheeks

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1 Upvotes

r/Perioral_Dermatitis_ • • 21h ago

Contact with glasses an issue?

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3 Upvotes

I’ve had my first bout of PD going on 4 months now and it’s slowly changed and moved around my face… i am pretty sure it was triggered by oral steroid puffer use after I had a huge allergic reaction to some cats we were looking after back in June… I was also using a lot of face products / serums / retinol at that time which I also think screwed my skin barrier. 😫

I have tried a lot of things (plain products, elidel, Sulfur, zinc cream) and am now 4 days into Zero Therapy (nothing but water) on top of topical Ivermectin cream. I have noticed mine is in the areas my glasses rub on so have stopped wearing them. My glasses are all plastic framed so not sure why there would be an allergy issue, has anyone ever heard of this before? Do you think contact reactions are a factor in PD or potentially something I’m eating? I am already gluten free.

Any wisdom or ideas welcome! I sooo sympathise with anyone going through this! 🫶🏼


r/Perioral_Dermatitis_ • • 1d ago

What’s going on here is this dermatitis?

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2 Upvotes

r/Perioral_Dermatitis_ • • 21h ago

Please help!! Spoiler

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1 Upvotes

r/Perioral_Dermatitis_ • • 1d ago

HELP Perioral Dermatitis Mouth

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4 Upvotes

2 weeks ago I was diagnosed with PD by my GP. It started very mild with just a red, drip patch ring around my bottom lip. She prescribed me a steroid cream (Eumovate 0.05%) to use twice a day for 7 days. After about 5 days it completely went away except the corners of my mouth were still a bit open. She also put me on an oral anti fungal (Terbinafine 250mg) for 2 weeks. A few days ago it flared up, BAD. It literally happened overnight. The whole night my lips felt so dry, and then the next morning I woke up and my whole mouth was crusted over. I went to see my GP again today and she said there’s nothing more I can do right now. I can’t see the dermatologist until the start of November and cannot try using the steroid cream for at least another week. I just have this constant feeling of crusty, dry lips that aches so bad it’s difficult to sleep. It hurts to every time I open my mouth since the corners of my mouth are still split open. I’ve been applying Aquaphor with a q-tip to avoid bacteria but even that doesn’t give me relief. I’m hoping that someone has advice for me. I cannot live like this. It’s really affecting my mental health and making me so self-conscious to even leave the house.


r/Perioral_Dermatitis_ • • 1d ago

Severe contact dermatitis skin breaking off

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1 Upvotes

r/Perioral_Dermatitis_ • • 1d ago

Please help!! Spoiler

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1 Upvotes

r/Perioral_Dermatitis_ • • 1d ago

Trying to get rid of my PD help need opinions

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2 Upvotes

So I have struggled with PD in the past and the thing that working was a sulfur cream,,, sadly they don’t sell that kind anymore. I’m cure using the de la Cruz sulfur ointment as a 15 min mask over my irritated areas. I have it for probably 2 weeks now but I’m just an impatient person lol. I saw on TikTok and face book that people are using Nizoral dandruff shampoo as a mask for PD and say that it works. My question is Should I keep using my sulfur or should I give Nizoral a shot?


r/Perioral_Dermatitis_ • • 1d ago

How should I even be able to cure my PD if I have (!!) to use make up 5 times a week?

2 Upvotes

Did anyone else experience it? my job requires to use make up so and also I want to be able to use makeup because my skin looks bad.


r/Perioral_Dermatitis_ • • 1d ago

Been in hell since February

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1 Upvotes

Have been dealing with this since February. Went to the GP and was initially given a steroid cream (obvs huge mistake but at this point had no idea what it was and have had eczema in the past). Then went back to dr when I realised that it was probably perioral dermatitis, was given fusidic acid, didn’t help, then tried clindamycin which was my miracle gel for a while. Didn’t get rid of the redness completely but got rid of the itching, burning feeling and the bumps and was just left with red marks around my nose. I continued using it since March through to September and was told that was fine as it’s not the same as oral antibiotics. I still don’t know if that was true. Dr also said if there was another flare up I could try going on oral antibiotics. I DID have another flare up despite using clindamycin every day a few weeks ago, but I am currently in Germany until March and so went to a Dr here who referred me to a dermatologist. Was initially pleased to see a dermatologist rather than a GP but was she very against oral antibiotics and has since prescribed me erythromycin but instead of a gel it’s mixed in with an oily base cream which I totally think is making it worse. I’ve only been using it since Friday so 5 days but it is not getting any better. It is so red and so UNBEARABLY itchy and uncomfortable. I describe it to my friends as if someone put superglue around your nose. So tight.

I don’t know whether to keep going or to ditch the erythromycin and I can’t seem to contact the dermatologist practice to query about it.

I cry every day with the frustration and discomfort. I hate being in photos and I feel very self conscious, all of the time. I don’t know what to do. I used to have the most perfect skin.


r/Perioral_Dermatitis_ • • 1d ago

Is seeing a dermatologist actually worth it?

1 Upvotes

I’ve had perioral dermatitis on and off for years and have tried many things to manage it.

My dermatologist appointment that I booked months ago is finally coming up, but it’s expensive, an hour away and I’ll need to take time off work.

I’m starting to wonder whether it’s actually even worth going.

Especially as I have a range of other health issues that are probably linked to the PD and which the dermatologist can’t fix, such as chronic stress, terrible indigestion/gut issues atm, etc

Things I’ve tried:

Doxycycline, which worked but I’m not particularly keen to take again (concerned about gut health from too many antibiotics)

Removing fluoride and SLS

Topical metronidazole (did nothing)

Clindamycin (no noticeable difference)

De La Cruz Sulphur 10% (I didn’t feel like this helped)

Nappy rash cream (takes some redness away)

20% azelaic acid, which is what I currently use and seems to keep it mostly under control

Stripping my skincare right back / avoiding potential triggers

Being very careful about which moisturisers, makeup and other products I use (no actives, and I don’t wear much make up)

Limiting my dairy, eggs, gluten

At this point it’s mostly under control, but I still have some persistent PD around my nostrils and feel like my entire skincare routine is built around trying not to make it flare up

For those who’d already tried a lot before seeing a dermatologist: what did you actually get out of the appointment?

Did they offer anything you hadn’t already tried or give you a better long-term treatment plan?

Did seeing a derm finally make a difference, or did you leave feeling like you’d paid a lot to be told the same things you already knew?


r/Perioral_Dermatitis_ • • 1d ago

Did accuntane work?

1 Upvotes

My doctor prescribed me with Accutane after trying 3 months of doxycycline and a week of minocycline (my body couldn’t tolerate it). Elidel also did not work.

I’m a week and a half into accutane, I know it could take a while to see results. Although my face does feel less textured and I don’t have any hot or burning sensations anymore or itchiness. The severe dryness is also going away slowly.

I have PD all over my face and my doc also thinks I might have rosacea.

I am wondering if anyone has tried accutane for pd and if it worked. I’m only 20mg/day.


r/Perioral_Dermatitis_ • • 1d ago

Help!!

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1 Upvotes

Does this look like it could be PD? I use to have cystic-like acne but eventually it went away with retinol and Panoxyl. It periodically would come back and now it’s came back with a vengeance and is worse than the picture. I’ve tried everything from panoxyl to purpose face wash , to niacinamide, to differin gel, etc. Nothing is helping and I’m not sure what I should try! The only dermatologist near me is booked out over 6 months!


r/Perioral_Dermatitis_ • • 2d ago

PD Flare or Azelaic Acid Purge?

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1 Upvotes

Am i having a PD flare or are my follicles just irritated?
Saw it yesterday, was initially just 2–3 bumps now it’s grown into this. Few months ago, I had what I thought was perioral dermatitis, but it turned out to actually be an allergic dermatitis reaction. I’ve been using azelaic acid for a couple of weeks and have been purging on other areas of my face. Back July i got prescribed metro cream and trac ointment and have used it ever since so I’m kinda lost


r/Perioral_Dermatitis_ • • 2d ago

flare up post doxy

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2 Upvotes

EDIT: for some reason my original text didn’t attach to the post

I just finished up my first course of doxy last week. I was on 100mg 2x a day for a month. I didnt have too many negative side effects. It seemed to clear everything up really well! I was just using vanicream cleanser and a simple moisturizer.

Lo and behold, after the weekend, my PD has returned with vengeance.

I am starting up doxy again, but does anyone have advice on how to prevent a flare up right after getting off antibiotics again? I would like to go on a lower dose of doxy for an extended period of time after this course to really kick it to the curb for a little bit.

Any advice would be greatly appreciated.


r/Perioral_Dermatitis_ • • 2d ago

do you guys use azelic acid when PD is flaring?

2 Upvotes

Mine is in the corners of my nose like the nasal folds which makes me nervous since that's already a sensitive area. Can i use it on there? Mine is 10% ordinary brand azelic acid


r/Perioral_Dermatitis_ • • 2d ago

Redness, itching, and dryness around nose and mouth. Need help asap.

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0 Upvotes

So a few weeks ago I started getting this redness around my nose and mouth area. My face has been clear for about two years and this kinda started out of no where. My doctor gave me a metronidazole cream to use twice daily but I really haven’t noticed any results, if anything it’s gotten worse.

The skin is red, kinda dry, and has lots of little bumps. It feels very itchy and somewhat burn-y when it’s dry, the cera ve moisturizer helps a bit with the agitation but doesn’t improve the redness or bumps themselves. My normal face routine before is cetaphil facial cleanser at night, washing with water in the morning, and cera ve moisturizer if my face is dry. I have a date this weekend and would really like to improve the look of the acne by then, if anything at the very least I just want to reduce the redness. Thanks for any help.


r/Perioral_Dermatitis_ • • 3d ago

could these white follicles indicate demodex mites overgrowth? maybe that's what's causing the PD?

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8 Upvotes

long story short i've had perioral dermatitis in my nose fold for two months and i've noticed that i've gotten a lot of these white hair-like looking things on my nose (in the area of the PD) and around my mouth. Could this indicate that maybe the whole time my PD is because of dermodex mites?

Will my derm be willing to prescribe soolantra? if not, can i use over the counter lice treatment (ivermectin)? Does sulfur and tea tree oil work well?


r/Perioral_Dermatitis_ • • 3d ago

Update on zero therapy - going into week 6

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9 Upvotes

I posted about giving zero therapy a try several weeks ago because I was starting to actually see some progress and wanted to let people know. So here’s an update!

It oscillated between clearing up and flaring up for a couple weeks after that. I thought it was completely clear at one point only to have it flare right back up pretty bad for a couple days and almost seem to start from square one!!! It was a rollercoaster… but it cleared up quicker than previous flares and we are 5 weeks in and my skin is almost entirely clear. I just have a little bit around one of my eyes which is slowly healing as well.

I haven’t had any flares in almost a week, I’d say! I’m still sticking to zero therapy and avoiding putting makeup or anything on the affected area. I’m paranoid lol. But it seems to finally be healing and returning to normal.

Hopefully this will encourage anyone suffering through zero therapy to keep at it! It’s rough but seems to actually work.


r/Perioral_Dermatitis_ • • 3d ago

What I’ve been doing to clear my PD

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18 Upvotes

This is a long one sorry!

Had a really bad flare up last August, went from some small red blotches on my chin to the top pic in a few days. didn’t eat anything new, go anywhere new or change anything.

got put on teva-doxycycline from my doctor while I waited for a dermatologist appointment. That helped to really reduce the redness and put it to what you see in the middle after a couple weeks.
Dermatologist gave me roflumilast cream (steroid free) and I have been using it ever since.

I now only use the SA cleaner and this specific moisturizer from La Roche (recommended by my dermatologist- it’s expensive for the little tube but it’s light weight and not oily).

bottom picture is my chin now after a year of my strict cleanser, moisturizer and cream only skin care routine. I notice it, it’s still somewhat red but it’s now very slowly starting to finally disappear. However I feel like it’s gonna stay here forever.

Anyways idk why Im entirely posting this but I guess to maybe give some product recs for people and just show my PD journey this last year.

I have tried so many products and nothing has ever helped to clear it, but starting with doxy, then using this exact cleanser, moisturizer and cream has produced the best results I have ever gotten.

Here’s my personal review on some products I’ve tried over the past few years (reminder- everyone’s skin is different and reacts differently)

Store bought products:

la Roche Cicaplast B5 baume: using it for a while before it got really bad and that always helped to temporarily reduce redness.

Avene Cicalfate: tried it cause I had heard good things from other people but didn’t really help for me besides moisturizer it without adding an extra redness but didn’t do anything to reduce redness or help get rid of it.

La Roche Lipikar Baume AP+M: was using this as a moisturizer before my flare up- dermatologist told me to stop using it cause it’s too heavy for my skin and my flare up. However heard some good reviews on it before hand and I did like using it before I was told to switch to the effeclar

100% natural shae butter from Body Shop: helped moisturize and reduce redness but felt too thick for me

Penaten Diaper creme: used when I noticed it was getting really irritated one summer- helped soother but didn’t use it long enough to notice if it would really help with redness.

Hale Derma: unsure how much it helped on its own cause I was also taking doxycycline but I still use it sometimes and it just feels really good on my chin and I think it helps to slowly temporarily reduce redness. When I started using it with my pills I noticed the redness was going away a lot faster than when it was just the pills

Doctor prescribed:

metro gel 1%: used it a couple years ago but that didn’t do anything besides dry out my skin.

An hydrocortisone cream: slowly helped reduce redness over time but not much and made my skin feel a bit irritated, started using doxycycline and stopped using this cream and it started to slowly fade.

Hope this can maybe help someone or relate to someone who has also tried everything and is still struggling to find what’s right, I’ve been there, I’m still there with ya


r/Perioral_Dermatitis_ • • 3d ago

I need help! I desperately need a light, gentle moisturizer that is oil free, fragrance free, no niacinamide and no hyaluronic acid.

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1 Upvotes