Periorifical Dermatitis 101
If you've ever dealt with an angry rash creeping around your mouth, nose, or eyes, there's a good chance it was periorificial dermatitis. It's one of those skin conditions that can feel like a cruel joke: it looks like acne, reacts like eczema, and defies every soothing product you want to reach for. And yes, it's as frustrating to treat as it sounds.
In this post, I’ll break down what periorificial dermatitis actually is, what causes it, why it’s so stubborn, and how to manage it (without accidentally making it worse).
And spoiler alert: step away from the steroid cream. We talk more about this in Episode 8 of the Derm Next Door podcast, which drops soon.
What Is Periorificial Dermatitis?
Periorificial dermatitis is an inflammatory facial eruption that typically shows up around the mouth, nose, and eyes (hence the name: peri- meaning around, orificial meaning openings).
It often appears as:
Small red or flesh-toned papules or pustules
Clusters that resemble acne but without true comedones
A background of dry, irritated, or scaly skin
It can be itchy, tender, or just...persistent.
What Causes It?
The exact cause is still under investigation, but here's what we know: it’s often triggered or worsened by outside factors, especially those that mess with the skin barrier or microbiome.
Common culprits include:
Topical corticosteroids- the #1 offender (including over-the-counter hydrocortisone)
Heavy occlusives or emollients- yes, even your beloved slugging routine
Fluoridated toothpaste
Hormonal fluctuations
Microbial imbalance- including demodex mites and certain bacterial triggers
Barrier-disrupting skincare- like exfoliants, acne meds, or essential oils
Overuse of makeup or sunscreen that traps moisture
Does It Wax and Wane?
Oh yes. Periorificial dermatitis can be cyclical, often flaring with stress, heat, product changes, or after steroid withdrawal. One day your skin looks clear, the next you’re back in perioral purgatory. It’s part of what makes this condition so maddening; it requires both patience and detective work.
Why It’s So Tricky to Treat
Unlike acne or eczema, there's no one-size-fits-all approach here. Treatment often involves a combination of factors, including:
Gentle skincare modification: removing triggers like occlusives and steroids
Topical medications: such as metronidazole, azelaic acid, or calcineurin inhibitors
Oral antibiotics: like doxycycline or minocycline, especially in more stubborn or widespread cases
Lifestyle and product changes: less makeup, fragrance-free everything, and barrier-friendly swaps
Even for dermatologists, this condition can be a puzzle, which is why we dedicate a full segment to it in Episode 8 of the Derm Next Door Podcast. Stay tuned!
Best Products for Periorificial Dermatitis-Prone Skin
Here are a few derm-approved products that support healing without triggering a flare. Crucially, they’re free from fragrance, occlusives, and harsh actives.
| Product | Why It’s Helpful |
|---|---|
| Vanicream Gentle Facial Cleanser | Fragrance-free, non-irritating, perfect for barrier repair |
| Vanicream Daily Facial Moisturizer | Lightweight, non-comedogenic, no heavy occlusives |
| La Roche-Posay Cicaplast Balm B5 | Soothing panthenol + madecassoside; great for healing without clogging |
| Avoid: Occlusive ointments | Even though I love CeraVe Healing Ointment, I skip it here |
| Avoid: Topical Steroids | Will give short-term relief, but rebound worse. Trust me |
TL;DR:
Periorificial dermatitis is a stubborn inflammatory condition, often around the mouth or eyes
Steroids and occlusives are the usual suspects
Healing requires a full routine reset: gentle skincare, possible topicals, and often oral meds
Consistency is key, and even then, flares can happen, but with the right approach, it is manageable