Condition

Perioral Dermatitis

Perioral dermatitis is a rash of small bumps and fine flaking around the mouth, and sometimes around the nose and eyes. Steroid creams are the most common trigger, and they are also what makes it worse in the long run. It clears with the right treatment, but slowly.
Dr. Schwarz, MD · Board-certified dermatologistLast reviewed September 8, 2026
Close-up of small pink bumps and flaky skin clustered on the chin below the lower lip

Start here

The story is the same every time - a rash around the mouth, someone suggests hydrocortisone, it clears in two days, then comes back worse the moment the cream stops. That cycle is the condition, not bad luck. My hardest instruction here is to do less - stop the steroid, stop the heavy creams, stop the acids and scrubs, and put almost nothing on your face while the prescription works. Expect a flare in the first week or two off the steroid, because not knowing that is what sends people back to the tube.

— Dr. Schwarz, Board Certified Dermatologist

Key Facts

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How commonCommon, though far less well known than acne or rosacea
Who gets itMostly women between about 16 and 45. Children get a version of it too, often linked to inhalers or steroid creams
Curable or managedUsually curable - most cases clear fully and stay clear once the trigger is removed
Prescription neededUsually yes. Over-the-counter treatment on its own rarely clears it
Time to improveSeveral weeks to start, and often 2 to 3 months to clear completely

What It Is

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Perioral dermatitis is a rash of small bumps, sometimes with tiny pus-filled heads, on patches of pink, dry, flaking skin. It sits around the mouth, and often the nostrils, chin and folds beside the nose. When it involves the eyes or eyelids it is called periorificial dermatitis, the more accurate name for the whole condition.

The most useful clue is a clear rim of normal skin next to the lip border, usually a few millimeters wide. The rash stays outside that rim.

It burns, stings or feels tight rather than itching. The bumps are uniform and grouped, with no blackheads or whiteheads, which is what separates it from acne. It also resembles rosacea, an allergic reaction and seborrheic dermatitis, and often gets treated as all of them first.

Children get a version that looks the same, and less often a variant with firmer, flesh-colored bumps called granulomatous periorificial dermatitis. It is not dangerous, not contagious, and it does not scar, but it is uncomfortable, visible, and takes weeks rather than days to clear.

Symptoms

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Bumps with a clear rim

Around the Mouth

Small red bumps and fine scale around the mouth, with a narrow clear zone right at the lip border. It burns or stings more than it itches. Steroid creams settle it briefly and then make it worse.
The same rash higher up

Around the Eyes and Nose

The same bumps sitting around the nostrils, the eyelids or between the brows, sometimes without any mouth involvement. It is often mistaken for acne or eczema. The treatment is different from both.
Firm skin-colored bumps

Granulomatous

Firmer, skin-colored or yellow-brown bumps, seen more often in children and in deeper skin tones. It is less red than the usual form so it can be missed. It settles more slowly but does settle.

Where It Shows Up

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Front view of a head with red marks in the creases beside the nose, at both corners of the mouth and on the chin, with the border of the lip itself left clear.
Around the mouth, with a clear rim at the lip
The rash rings the mouth and runs up into the creases beside the nose, but it leaves a narrow clear band of skin right at the lip border. That spared rim is the single most useful clue, and it is what separates this from acne and from rosacea.
Front view of a head with red marks around both eyes, under both eyes and in the creases beside the nose.
Around the eyes and nose
The same rash can appear around the eyes and around the nostrils instead of, or as well as, around the mouth. Steroid creams — including ones used for something else nearby, and inhaled steroids — are the commonest trigger, and stopping them makes it flare before it settles.

What Happens in the Skin

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This is what is going wrong under the skin, in the order it happens. Click a step to see it.

How Perioral Dermatitis happens
Skin basics
BARRIEREPIDERMISDERMISPOREOILGLAND0NORMAL SKIN1THE SKIN BARRIER IS DAMAGED2STEROID EXPOSURE ON THE FACE3OVERGROWTH AROUND THE FOLLICLES4INFLAMMATION, AND THE RASH APPEARS

The skin around the mouth and nose is thinner than the rest of the face and dotted with small hair follicles. Its outer layer holds water in and keeps products out. Left alone, the mites and bacteria living around those follicles stay in small, quiet numbers.

Heavy moisturizers, balms, full-coverage makeup, layered acids and over-washing all disturb the outer layer of the skin around the mouth and nose, so it stops holding water in and keeping irritants out.

A steroid cream on the face, or medicine that lands there from an inhaler or a nasal spray, quiets the skin's immune response while it is being used. When it stops, the reaction comes back stronger than before.

With the barrier disturbed and the immune response damped down, the organisms that normally live quietly around the hair follicles, including Demodex mites and some bacteria, grow in numbers.

The skin reacts around each follicle, and that is the rash you can see: grouped small bumps, some with tiny pus-filled heads, on pink flaking skin that burns rather than itches. Almost everything in the lists below is pushing on this step.

The outer film of dead cells and oil. It holds water in and keeps irritants out, and it is thinner than a sheet of paper. Almost every dry, itchy, stinging skin problem starts here.

The outer layer, and the only one anything in a jar reaches. It renews itself constantly: a cell made at the bottom takes about a month to reach the surface and flake off. Most of what a skincare product does, it does here.

The living layer underneath, holding the blood vessels, the nerves and the collagen. It is where lasting change happens and it is hard to reach: most of what is sold for the skin never gets this far.

The exact cause is not known. The pattern of triggers is well established.

The clearest trigger is steroid on the face. Topical steroids, even mild ones like hydrocortisone and even for a short course, can set it off, and so can steroids reaching the face indirectly: asthma inhalers, nasal sprays, and steroid creams transferred by the hands. The pattern is characteristic. The rash improves quickly while the steroid is used, then rebounds worse when it stops, which pulls people back into using it.

The second thread is barrier damage. Heavy occlusive moisturizers, thick foundations, lip balms and long stretches of layering actives all disturb the outer layer of skin and often precede a case. Once the barrier is disrupted, the skin around the hair follicles becomes inflamed, and organisms that normally live there quietly, including Demodex mites and certain bacteria, may grow in numbers and add to it.

Weaker associations come up often - fluoride toothpaste, hormonal shifts, sun exposure. The evidence is much thinner than for steroids and heavy products, so treat them as a trial rather than a rule.

Risk Factors

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Some people are far more likely to get this than others, and most of the list is about exposure, not anything you did wrong.

Steroid exposure
Using a steroid cream on the face
The strongest single risk factor. Even over-the-counter hydrocortisone for a week can trigger it.
Steroid exposure
Inhaled or nasal steroids
Inhalers and nasal sprays deposit medicine around the mouth and nose. The usual route in children.
Steroid exposure
Products of uncertain content
Unlabeled or imported creams may contain steroids that are not declared.
Habits & products
Heavy or occlusive facial products
Thick moisturizers, oils, balms, primers, full-coverage foundations.
Habits & products
An elaborate skincare routine
Multiple actives, frequent exfoliation and constant product changes disrupt the barrier.
Age & hormones
Being a woman aged roughly 16 to 45
By a wide margin the most affected group, though anyone can get it.
Age & hormones
Hormonal shifts
Flares are reported around hormonal changes and with hormonal contraceptives, though the link is loose.
Skin type
Sensitive or eczema-prone skin
Atopic skin seems more susceptible, and is also more likely to have steroid creams on hand.

Course

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Perioral dermatitis does not usually settle by itself. The steroid cycle defines its course - a cream calms the rash within a day or two, then it returns worse once the cream stops. Once treatment starts the arc is predictable, and the first part is worse before better.

OnsetDays to two weeks
It follows a trigger

It appears over days to a couple of weeks, usually after a new product, a steroid cream, or a stretch of heavier makeup or moisturizer.

UntreatedMonths
It drifts between better and worse

Left alone it persists for months. Steroid creams are the trap - each round calms it, then it comes back worse, needing more steroid for less benefit while the condition gets harder to treat.

Weeks one and two of treatmentThe expected flare
Worse before better

Expect the first one to two weeks to be worse, particularly if a steroid is being withdrawn. It is temporary.

Weeks three to sixTurning the corner
Improvement becomes clear

This is when change becomes obvious. Stopping at the first sign of improvement is the usual cause of relapse, so finish the course.

Two to three monthsClearing
Most people clear completely

Full clearing commonly takes two to three months. This is one of the few facial rashes that genuinely goes away, and most people stay clear as long as the triggers do. When it returns the trigger is usually identifiable - a steroid cream for something else, a new heavy product, or a long routine again.

What Makes It Better & Worse

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Perioral dermatitis is four problems - a damaged barrier, steroid exposure, follicular overgrowth, and inflammation. Most of the treatment is subtraction rather than addition, so stopping products helps as much as any prescription.

What is driving yours?

FATPOREOILGLANDBARRIEREPIDERMISDERMIS

Heavy moisturizers, balms, full-coverage makeup, layered acids and over-washing all disturb the outer layer of the skin around the mouth and nose, so it stops holding water in and keeping irritants out.

A steroid cream on the face, or medicine that lands there from an inhaler or a nasal spray, quiets the skin's immune response while it is being used. When it stops, the reaction comes back stronger than before.

With the barrier disturbed and the immune response damped down, the organisms that normally live quietly around the hair follicles, including Demodex mites and some bacteria, grow in numbers.

The skin reacts around each follicle, and that is the rash you can see: grouped small bumps, some with tiny pus-filled heads, on pink flaking skin that burns rather than itches. Almost everything in the lists below is pushing on this step.

What helps

  • Strip the routine back Gentle cleanser, light moisturizer, sunscreen, nothing else.
  • Simplify makeup rather than stopping it Light mineral makeup, removed gently.
  • A simple daily sunscreen Stops the dark marks deepening.

What makes it worse

  • Occlusive balms, moisturizers and oils Thick products trap and disturb the barrier.
  • Full-coverage makeup and primers The heavier the product, the more it turns up.
  • Layering actives, acids and scrubs Stacked, they strip the barrier.
  • Lip balms used constantly, and lip licking Keeps the skin beside the lips wet.
  • Hot water, harsh cleansers, over-washing They strip a damaged barrier further.

What helps

  • Stop the steroid The first step; everything else depends on it.
  • Rinse after your inhaler or nasal spray Removes the residue.
  • Expect the rebound and wait it out The first one to two weeks are worst.

What makes it worse

  • Steroid creams on the face The clearest trigger, hydrocortisone included.
  • Restarting the steroid in the rebound That decision restarts the cycle.
  • Inhaled and nasal steroids without rinsing Medicine settles around the mouth and nose.

What helps

  • Topical metronidazole The long-standing first-line cream.
  • Topical azelaic acid Well established, and it helps the dark marks.
  • Topical erythromycin or clindamycin For cases the first choice misses.
  • Topical ivermectin Used when follicular mites are suspected.
  • An oral tetracycline course Clears widespread cases faster than creams.
  • An oral macrolide for children Used instead of a tetracycline.
  • Finish the course Two to four weeks after it looks clear.

What makes it worse

  • Face masks and anything occlusive Heat, moisture and friction for hours.
  • Stopping the prescription early Improvement at week three is not clearance.

What makes it worse

  • Fluoride toothpaste Reported by some, though the evidence is weak.

Your Routine

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Good skincare advice is hard to find. This routine is built on treatments with real evidence behind them, not on whatever happens to be trending.

Perioral Dermatitis
Perioral Dermatitis
AM
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PM
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How These Treatments Work

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Treatments for Perioral Dermatitis do not all work in the same place. Tap one to see where it acts.

Pick a treatment
Skin basics
BARRIEREPIDERMISDERMISPOREOILGLANDREMOVES THE CAUSECALMS THE FOLLICLEQUIETS THE INFLAMMATIONREMOVES THE TRIGGER

Steroids on the face keep this going and make it flare when you stop. It gets worse before it gets better.

Works on the organisms and the inflammation around the follicle opening.

For stubborn or widespread cases, usually for a few weeks.

Heavy creams and anything occlusive on the face feed it.

The outer film of dead cells and oil. It holds water in and keeps irritants out, and it is thinner than a sheet of paper. Almost every dry, itchy, stinging skin problem starts here.

The outer layer, and the only one anything in a jar reaches. It renews itself constantly: a cell made at the bottom takes about a month to reach the surface and flake off. Most of what a skincare product does, it does here.

The living layer underneath, holding the blood vessels, the nerves and the collagen. It is where lasting change happens and it is hard to reach: most of what is sold for the skin never gets this far.

Over-the-Counter Products

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Everything here you can buy without seeing anyone.

Cutting the routine back to nothing
Cutting the routine back to nothing
Moderate evidence
Stopping the steroid and taking everything else off the face is the single most useful thing you can do without a prescription: gentle cleanser, light moisturizer if you need it, sunscreen, nothing else. It works because most of this condition is caused by what is being applied. It is slow on its own, and the first one to two weeks are worse rather than better.
Five azelaic acid tubes and bottles on white, most marked 10 percent, from Peach Slices, Paula's Choice, Facetheory, The Ordinary and NaturiumDiagram: how Azelaic Acid 15% (Finacea) works in the skin
Moderate evidence
The one over-the-counter active worth using here. At 10 percent it calms the bumps and, unusually, also helps the dark marks the rash leaves behind. It is slower than the prescription version and it can sting on skin that is already burning, so start every other night.
Four sulfur acne products: Kate Somerville EradiKate, De La Cruz 10% sulfur ointment, The Ordinary and Thayers16:9 hero for Sulfur. Never cropped: the tone strip and the corner logo depend on the full frame.
Limited evidence
A sulfur wash or lotion is a gentler option for mild cases, and it is often chosen when someone cannot use the usual prescriptions. The evidence for it in this condition is thin, and the smell puts people off. It is worth a few weeks, not a few months.
Acne washes, acids and scrubs
Acne washes, acids and scrubs
Weak evidence
Benzoyl peroxide, strong exfoliating acids and scrubs are what most people reach for, because this looks like acne. They damage the barrier further and usually make the rash angrier. If a product is stinging more than it was on day one, that is a reason to stop it, not to push through.
A plain white ointment tube lying on its side, labeled Hydrocortisone with a blue swoosh16:9 hero for Hydrocortisone. Never cropped: the tone strip and the corner logo depend on the full frame.
Never use
The most common self-treatment for this rash and the most common cause of it. It looks like it is working within two days, and the rash comes back worse when it stops, which pulls people into using it again. Even the mildest over-the-counter strength does this. If you are using one now, that is the thing to stop first, with your doctor's help if it was prescribed.

Prescriptions

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The basics stay put - a gentle cleanser, a moisturizer and a daily sunscreen are right whichever kind you have.

These need a prescription.

16:9 hero for Metronidazole (MetroGel). Never cropped: the tone strip and the corner logo depend on the full frame.Diagram: how Metronidazole (MetroGel) works in the skin
Strong evidence
The long-standing first choice for perioral dermatitis, used once or twice a day for weeks. It is well tolerated on skin that is already sore, which matters here. Expect little in the first fortnight, clear improvement by weeks three to six, and keep going for two to four weeks after the skin looks clear.
16:9 hero for Azelaic Acid 15% (Finacea). Never cropped: the tone strip and the corner logo depend on the full frame.Diagram: how Azelaic Acid 15% (Finacea) works in the skin
Strong evidence
As effective as metronidazole here, and the better pick if the rash has left dark marks, because it works on both. It stings for the first week or two on inflamed skin. Applied twice a day, it is a reasonable alternative rather than a step up.
A white metal tube lying at an angle on a white background, white ribbed cap to the left, labeled Clindamycin in black lettering with a teal swoosh curving beneath the word.Diagram: how Clindamycin works in the skin
Moderate evidence
An antibiotic lotion or gel kept for cases that do not settle on the first choice, sometimes paired with it. It calms the bumps rather than the flaking. It is not used on its own for long stretches, to limit resistance.
A white cream tube lying on its side on a white background, with a plain white label reading Erythromycin and a blue swoosh beneath it.
Erythromycin
Moderate evidence
An antibiotic gel with a long record in this condition, often chosen for children and for people who cannot take tablets. It is mild on the skin. If you are pregnant, ask your doctor which treatment to use, since the usual alternatives are avoided.
16:9 hero for Ivermectin Cream (Soolantra). Never cropped: the tone strip and the corner logo depend on the full frame.Diagram: how Ivermectin Cream (Soolantra) works in the skin
Limited evidence
Used when Demodex mites around the hair follicles are thought to be part of the picture, which is more likely in a stubborn case with a lot of small pus-filled heads. Most of its evidence comes from rosacea rather than this condition. It is a second or third choice, not a starting point.
16:9 hero for Pimecrolimus (Elidel). Never cropped: the tone strip and the corner logo depend on the full frame.Diagram: how Pimecrolimus (Elidel) works in the skin
Limited evidence
A non-steroid anti-inflammatory cream sometimes used to get through the rebound after a steroid is stopped, and around the eyes where other options are awkward. It calms the skin without the rebound a steroid causes. Results in this condition are mixed, and it can burn for the first few days.
A white cream tube lying on its side on a white background, with a plain white label reading Steroid Cream and a blue swoosh beneath it.
Steroid creams of any strength
Never use
Prescription steroid creams do the same thing on the face as the over-the-counter one: fast improvement, then a worse rash when they stop. Stronger ones make the cycle harder to break and can thin the skin. If a steroid was prescribed for something else on your face, ask about stopping it rather than stopping it abruptly on your own.
An amber prescription bottle lying on its side on a white background with a plain white label reading Doxycycline, and six small round white tablets spilled out in front of it.Diagram: how Doxycycline works in the skin
Strong evidence
A tetracycline tablet taken for six to twelve weeks, used when the rash is widespread, stubborn or around the eyes. It works here as an anti-inflammatory rather than by killing an infection, so a low dose is often enough. It makes the skin burn more easily in the sun, and it is not used in young children or in pregnancy.
16:9 hero for Minocycline. Never cropped: the tone strip and the corner logo depend on the full frame.Diagram: how Minocycline works in the skin
Moderate evidence
An alternative tetracycline when doxycycline does not suit. It works about as well for this rash. It is used more cautiously because it can cause dizziness and, rarely with long use, a blue-gray discoloration of the skin.
An amber prescription bottle lying on its side on a white background with a plain white label reading Erythromycin, and six small round white tablets spilled out in front of it.
Erythromycin for children
Moderate evidence
When a child needs tablets, a macrolide is chosen instead of a tetracycline, which is avoided under about eight because of the effect on developing teeth. It clears the widespread childhood form well. Stomach upset is the usual reason people stop it.
A white blister pack photographed flat on a white background, holding eight white oblong capsules in two rows of four under clear domes. ACCUTANE is printed in blue capitals on the empty left half of the foil.
Accutane (isotretinoin)
Limited evidence
A low dose is occasionally used for the granulomatous form or for a case that has failed everything else, and it is rare for this condition to need it. The evidence is a handful of small reports rather than trials. It requires close monitoring and strict pregnancy prevention, and it can dry the face enough to irritate the rash at first.

Procedures

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These are done in the office, usually over several visits.

No procedures listed yet.

When to See a Dermatologist

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Get seen early for this one, for an unusual reason - what you can buy over the counter either does not clear it or makes it worse, and steroid creams are both the commonest self-treatment and the commonest cause. Book if small bumps around the mouth, nose or eyes have lasted more than a couple of weeks, if it flared each time you stopped a steroid cream, if it is spreading toward the eyes, if it burns or stings through the day, or if it is happening in a child. Ask for an urgent appointment if the eyes become red, gritty or sore or your vision changes, and bring the packaging of anything you have put on your face, including creams from other people and unlabeled products. There is no test, so it is diagnosed on appearance and history - the key question is whether a cream helped and the rash flared when you stopped, because that rise-and-rebound pattern is close to diagnostic.

— Dr. Schwarz, Board Certified Dermatologist

Complications

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The steroid rebound cycle

A steroid cream calms the rash within a day or two, then it returns worse when the cream stops. Each round tends to need more steroid for less benefit, and the condition gets harder to treat. It is the most common complication of perioral dermatitis and the main reason cases drag on for months. Stopping the steroid, and expecting one to two bad weeks, is what breaks it.

Spread around the eyes

The same rash can move up onto the eyelids and the skin around the eyes. It is uncomfortable there, it takes longer to settle, and treatment has to be chosen carefully because of how close it is to the eye. If the eyes themselves become red, gritty or sore, or your vision changes, that needs looking at on its own and soon.

Months of a visible facial rash

This rash sits in the middle of the face, it burns through the day, and it commonly takes two to three months to clear even when treatment is right. People cover it with heavier makeup, which feeds the problem, and many stop seeing friends or go to work uncomfortable. It is worth saying out loud at the appointment, because it changes nothing about the diagnosis and quite a lot about how the plan is set up.

Lookalikes

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Acne

Both give small bumps with pus-filled heads on the lower face, and perioral dermatitis is treated as acne more often than as anything else. Acne also produces blackheads and whiteheads, and it turns up across the face, chest and back. Perioral dermatitis has no blackheads, keeps a clear rim of normal skin beside the lips, and burns or stings rather than itching. Acne washes and scrubs usually make it worse.

Rosacea

Both burn rather than itch, both give small bumps on pink skin, and both are made worse by steroid creams. Rosacea sits on the central cheeks, nose and forehead, comes with flushing and fine visible vessels, and does not spare a rim beside the lips. Perioral dermatitis rings the mouth, nose or eyes and usually clears for good, while rosacea is managed long term.

Seborrheic Dermatitis

Both sit in the folds beside the nose and both flake, so they are easy to mix up. Seborrheic dermatitis is greasier and scalier, with yellowish scale rather than bumps, and it usually shows up in the eyebrows, the scalp or behind the ears at the same time. Perioral dermatitis is made of distinct grouped bumps and stays around the mouth, nose or eyes.

Myths

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  • "It is acne, so I should treat it like acne." It is not acne and does not respond like acne. Acne produces blackheads and whiteheads; perioral dermatitis produces grouped uniform bumps with a clear rim beside the lips and no comedones. Strong acne actives and scrubs make it worse by damaging the barrier.
  • "A steroid cream will fix it." It will improve it for a few days, then make it worse. That trap is why so many cases drag on for months. A cream that helps dramatically within 48 hours and rebounds when you stop points to the diagnosis.
  • "It happened because my face is dirty." Cleanliness has nothing to do with it. The history usually involves too much washing and too many products, not too few.
  • "It is an allergy to my toothpaste." Fluoride toothpaste is reported as a trigger for a minority, but it is not an allergy and not the usual cause. Trying a non-fluoride toothpaste is reasonable if nothing else fits, but switching alone rarely clears it.
  • "Once you have it, you have it forever." Most people clear completely and stay clear, which separates it from rosacea. Recurrence usually has an identifiable cause, most often a steroid cream used for something else.
  • "I need a stronger moisturizer to fix the flaking." The flaking is inflammation, not dryness, and heavy moisturizers are a trigger group. A light, simple moisturizer is fine; a rich occlusive one prolongs it.

Questions Patients Ask

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Why did the steroid cream make it worse?

Steroids suppress inflammation quickly, so the rash fades within a day or two. They do nothing about what drives it, and when the cream stops the inflammation returns stronger, needing more steroid for less benefit. That is why the first step is always to stop.

How long will it take to clear?

Longer than most people expect. The first one to two weeks off a steroid are usually worse, improvement becomes clear around weeks three to six, and full clearing commonly takes two to three months. Judging at two weeks means judging it at its worst.

Is this acne?

No, though it is often treated as acne first. Acne produces blackheads and whiteheads, across the face, chest and back. Perioral dermatitis produces uniform grouped bumps around the mouth, nose or eyes, with a clear rim next to the lips, and it burns rather than itches.

Do I really have to stop all my skincare?

For a few weeks, mostly yes. Heavy occlusive products are a main trigger, and layered actives keep the barrier damaged. A gentle cleanser, a light moisturizer if needed, and sunscreen is the whole routine while it clears. Products go back one at a time afterward.

Will it come back?

Most people clear and stay clear. When it returns there is usually an identifiable reason - a steroid cream for something else, a new heavy moisturizer, or a long routine again. Knowing your trigger is most of the prevention.

Should I stop my asthma inhaler?

No. Never stop a prescribed inhaler on your own. Rinsing your mouth and washing the skin around it after every dose cuts the residue reaching your face, and your dermatologist can talk to whoever manages your asthma if the inhaler is the driver.

References

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