Understanding Perioral Dermatitis: Causes & Treatment | Rebecca Skin & Wellness

Have you woken up with a red moustache? Not the cool kind you’d twirl at a Victorian dinner party—but an angry, itchy, bumpy one. Maybe it’s sore, flaky, dry in some spots and oily in others. You’ve got clusters of little white pimples gathering around your nose, creeping down the corners of your mouth, maybe even under your chin. You’re probably thinking, “Ugh, an acne flare-up?” or “But I never get acne—what is this weird rash?!” Well, let me introduce you to Perioral Dermatitis, or PD, as we’ll call it here. As a skin therapist and wellness lover who went through this pesky condition myself—especially during the era of maskne and antibacterial everything—I’m here to help you understand it, soothe it, and most importantly, stop it from crashing your confidence.

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Dermatitis Types & What’s Causing Your Skin to Flare Up?

Let’s talk about three common (and confusing!) types of dermatitis: perioral, seborrheic, and contact. They all show up as red, irritated skin, but the causes and treatments can vary—although yes, gut health, inflammation, and your skin barrier always play a role. Here’s how to tell them apart:

Perioral Dermatitis

This one loves to linger around the mouth, nose, and eyes. It looks like clusters of red bumps, flaking, and sometimes a burning sensation. It’s often triggered by overusing topical steroids, fluoride toothpaste, and heavy skincare. But deeper down, it’s tied to gut imbalance, hormone shifts, and stress. Less is more here—strip back your skincare and support your gut from within.

Seborrheic Dermatitis

Think greasy, flaky patches—usually on the scalp, eyebrows, sides of the nose, and chest. It’s linked to an overgrowth of yeast on the skin, but again, the underlying cause often includes stress, gut dysbiosis, and even cold weather. A balanced diet, anti-inflammatory support, and gentle antifungal skincare can really help keep it in check.

Contact Dermatitis

This one’s more reactive—caused by direct contact with an irritant or allergen (think harsh soaps, fragrances, or even nickel). It shows up quickly with redness, itching, and sometimes blisters. Unlike the others, the trigger is usually external, but a resilient skin barrier and healthy immune response still come down to—you guessed it—internal inflammation and skin support.

I like to take a holistic approach for any skin issue - The wellness angle you could call it...

What do they all have in common? Your skin is communicating with you. Whether it’s barrier damage or inflammation bubbling up from the inside, it’s often a sign to slow down, review what you’re putting on and into your body, and nurture your gut, stress levels, and skin barrier.

What Is PD;

Perioral Dermatitis (PD) is a common inflammatory skin condition that primarily affects adult women between the ages of 20 and 45, though it can also occur in men and children—just less frequently. The term “perioral” quite literally means “around the mouth,” which explains the typical placement of this condition: small, red or white papules (bumps) often appear around the mouth, nose, and sometimes extend to the chin or even the eyes in more persistent cases.

PD can feel itchy, tender, flaky, or even slightly burning at times. It’s often mistaken for acne, rosacea, or simply dry, irritated skin—but while these conditions can look similar, PD is a distinct diagnosis with its own set of causes and treatment approaches. Importantly, it’s not contagious, infectious, or fungal in nature—it’s an inflammatory reaction, and often your skin’s way of saying, “Help! I’m overwhelmed.”

My own experience with PD;

I’ve experienced PD a few times in my life now, and every time it shows up, it completely knocks my confidence. The first time I had it, I was prescribed antibiotics and a steroid cream. I only used the cream once—I was desperate—but deep down I knew the long-term risks, so I stopped immediately. I stayed on antibiotics for 8 weeks, and while they did bring the inflammation and irritation down, the relief was temporary. Just a few weeks later, it came back with a vengeance.

As soon as I noticed the same symptoms creeping in again, I contacted my dermatologist. I was prescribed another round of antibiotics—but something in me knew I needed to dig deeper.

That’s when I started looking at everything I was putting on and into my body. My skincare routine was full of actives, acids, and harsh ingredients. I realized these were likely triggering the flare-ups. It wasn’t just one product—it was that my skin barrier was already compromised, and my immune system overloaded. That one product was simply the final straw.

I’ll never forget using the vampire blood peel from The Ordinary—it flared the PD up overnight around my nose. That was my wake-up call.

My Perioral Dermatitis Flare Up

From there, I completely changed my approach. I removed anything inflammatory from my diet—no dairy, gluten, alcohol, or coffee. I stripped my skincare routine right back. Just gentle, calming products to support and rebuild my barrier. No acids, no exfoliants, no actives. I also started focusing heavily on my gut health, especially after two full months of antibiotics.

And let me be honest: this condition doesn’t just affect your skin. It affects your self-esteem. I avoided seeing people. I didn’t want to be on FaceTime—even with my boyfriend. I was so self-conscious. Even brushing my teeth became a stress, because fluoride toothpaste made it worse.

Healing perioral dermatitis naturally takes time. It doesn’t disappear overnight—and in my experience, it always got worse before it got better. But if you’re going through this, know that you’re not alone and healing is possible. Here’s a list of what helped me:

What I did to heal my PD:

• Removed inflammatory foods (for me this was dairy and gluten)

• Removed all skin acids and active ingredients

• Focused on a gentle, healing skincare routine for 2+ weeks

• Cut out alcohol and coffee

• Focused on strengthening my skin barrier (no stripping products, no exfoliation)

• Lowered my cortisol levels by avoiding coffee first thing in the morning

• Drank celery juice every morning to support my gut and reduce inflammation

I can’t pinpoint one single thing that “cured” it. I truly believe it was the holistic approach—supporting my skin from the inside out, removing triggers, and giving my body the space and time it needed to heal.

If you’re going through it right now, please be kind to yourself and stay consistent. You will get through this.

The Main Triggers that may cause or flare up PD;

There isn't a clear indication of the exact cause, however there are many triggers that can cause PD and many links to hormone and stress. Here's some triggers that could have caused your PD.

1. Excessive skin cleaning + washing

2. Stress + Life style high cortisol

3. Food sensitivities / intolerances

4. Using too many acids on the skin

5. Heavy fragranced products and physical sunscreen

6. Steroid creams

7. Compromised gut microbiome (The Gut-Skin connection)

8. A weakened skin barrier

9. Hormone Fluctuations in Women

10. Smoking/Vaping

11. fluorinated in toothpaste

What is the best way to heal PD;

Strip your skincare routine right back to the absolute basics. I’m talking: oil-free, fragrance-free gentle cleanser, no makeup, a light oil-free moisturiser, and a mineral SPF. Look into gentle, barrier-supporting brands like La Roche-Posay or Avène—these were lifesavers for me. Stick to this simple routine until the PD has fully cleared, and only then slowly reintroduce your actives, one at a time.

Focus on removing the triggers we talked about and It’s also really important to contact a dermatologist to properly diagnose your skin condition.

One thing that really helped me and continues to support my skin is red LED light therapy. Red light has anti-inflammatory benefits, supports the skin’s natural healing process, and helps calm irritated skin without touching or aggravating the area.

How Red Light (LED) Can Help with Perioral Dermatitis:

• Reduces inflammation: Red light at specific wavelengths (typically 630–660nm) penetrates the skin and helps calm inflammation without heat or irritation.

• Boosts healing: It stimulates cellular repair and increases circulation, which can help speed up skin regeneration and reduce the lifespan of a flare-up.

• Strengthens the skin barrier: With regular use, LED therapy can help rebuild a compromised barrier, making your skin more resilient.

• Gentle & Non-invasive: It doesn’t require touching the skin—perfect for times when your skin is extra sensitive.

Main Factors in Healing PD:

1. Remove all harsh and triggering skincare products

2. Support your gut health—especially after antibiotics

3. Avoid steroids and use antibiotics only if needed, under supervision

4. Stick to a gentle, minimal routine (oil-free and fragrance-free)

5. Minimise stress and lower cortisol (no coffee first thing, get rest!)

6. Consider diet—eliminate inflammatory foods like gluten, dairy, and alcohol

7. Use LED light therapy to calm inflammation and support healing

8. Be patient and consistent—this takes time, not days

Controversial;

Western Medicine does not always

heal Perioral Dermatitis!

Let me start by saying—this might be a little controversial, and I’m not here to bash Western medicine. It absolutely has its place in the world, and there are many severe cases of Perioral Dermatitis that it is needed. But I’ve seen time and time again how conventional treatments can actually make things worse.

From personal experience and through countless conversations with clients, I’ve noticed a pattern: people go to their doctor or dermatologist with symptoms of Perioral Dermatitis, and they’re often misdiagnosed—or they’re immediately prescribed antibiotics or steroid creams.

Now, let me be really clear here: steroid creams and Perioral Dermatitis do not mix. Yes, at first, the cream might reduce the inflammation. You might even feel like it’s working within 24 to 48 hours. But then, without fail, the condition comes back—often worse than before. It spreads, flares up more aggressively, and becomes much harder to manage. I’ve seen it happen over and over again, and it’s happened to me too. That’s why I strongly advise against using steroid creams for this condition—they’re simply not a long-term solution.

As for antibiotics, they can be helpful in extreme cases by calming the itchiness and inflammation temporarily. But again, they’re a band-aid. Just like with seborrheic dermatitis, where people are prescribed medicated shampoos like Nizoral for years, we often forget to ask why the condition is happening in the first place. We treat the symptoms instead of finding the root cause.

Antibiotics don’t just kill the bad bacteria—they wipe out the good bacteria in your gut too. Since gut health is directly connected to skin health, this disruption can have a long-term impact. Conditions like acne, eczema, and perioral dermatitis can all be linked to imbalances in the gut microbiome.

Perioral dermatitis won’t go away by it self or with a quick fix.

If you truly want to heal it, you have to look beneath the surface.

For more tips and Advice on Skin + Wellness with Rebecca Follow on Instagram. I hope you enjoyed reading this and if you are struggling with PD I hope some of my experience can help you. Thanks for reading xx

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Disclaimer:

The content provided in this blog post is for informational and educational purposes only. All information shared is based on personal experiences and insights. The author does not claim to be a medical professional, Skin Doctor or Dermatologist and the content should not be construed as medical advice or a substitute for professional medical guidance. It is essential to consult with your doctor, therapist, or counselor before implementing any practices discussed in this blog post. The author holds no responsibility for any actions taken based on the information provided herein.

Thank you for your understanding.