How to treat perioral dermatitis

Noticed some red dots around your mouth and nose? This could be perioral dermatitis. Living with a skin condition can be hard, especially on your face. If you’re struggling to treat your skin, we can help you.

What is perioral dermatitis?

Perioral dermatitis, or periorificial dermatitis (1), is a common skin condition (2). Small red dots, and sometimes pus-containing spots, appear around the mouth and nose (2). They can also appear around the eyes (periocular dermatitis) (3).

Who does perioral dermatitis affect?

Perioral dermatitis mainly affects women aged 20 to 50 years old of any skin type (2). It can also affect children between 7 months and 13 years old (1).

What are the symptoms of perioral dermatitis?

Perioral dermatitis can cause the skin to feel dry, flaky, itchy, rough, and bumpy (1). The skin appears red, but redness may be harder to see on black or brown skin (2). Spots may look pink or purple instead (2).

Is perioral dermatitis the same as contact dermatitis?

Sometimes perioral dermatitis is mistaken for contact dermatitis (4). Contact dermatitis is caused by touching something that causes the skin to react, such as a chemical, or when you have an allergic reaction to something you’ve touched (5).

There are many types of dermatitis (also known as eczema) (5). Whilst they all affect the skin, they have different symptoms and causes, and affect different people and areas of the body (5).

Is perioral dermatitis the same as rosacea?

No, perioral dermatitis is not the same as rosacea (2). Unlike perioral dermatitis, it’s possible that rosacea is caused by immune system problems or passed down through families (6). Whilst rosacea has similar symptoms to perioral dermatitis (redness and spots), they tend to appear on the forehead, cheeks, nose, and chin (2).

Is perioral dermatitis contagious?

No, perioral dermatitis is not contagious (4). This means it can’t be passed on to other people.

How is perioral dermatitis diagnosed?

Perioral dermatitis is generally a clinical diagnosis (1). This means it is diagnosed with a doctor while looking at the skin and discussing symptoms. Sometimes further tests are carried out (1) such as:

• Patch tests to check for allergic contact dermatitis (1)
• Swabs to check for bacterial or fungal infections (1)
• Skin biopsy to check for other causes of redness and swelling (inflammation) (1)

What causes perioral dermatitis?

It is not clear what exactly causes perioral dermatitis (2). However, some products have been flagged as potential causes (1). The first step in tackling your perioral dermatitis might be to stop using:

• Topical steroids (also called corticosteroids) such as cortisone or hydrocortisone, or any steroid nose sprays or inhalers - you must check with your prescriber before stopping any of these on your own (7)
• Heavy make-up or thick skincare products (known as occlusives), such as petroleum jelly (Vaseline), oils or high oil content moisturisers that may be clogging your skin’s pores (1)
• Skincare products that are fragranced or not suitable for sensitive skin (1)

You should also try not to pick or pop any spots or touch your skin a lot (2). Use only lukewarm water to wash your face (2). This can help if your skin has flared up or you’re not sure which products are affecting your skin (2).

What else is linked to perioral dermatitis?

• Fluoride, found in most toothpastes, has been linked to perioral dermatitis (8). Fluoride helps to prevent cavities and protects from tooth decay (9). If you’re considering swapping to a fluoride-free toothpaste, it’s best to discuss this with your dentist first (9). In fact, mint and cinnamon flavourings that can be found in toothpaste, as well as chewing gums, have also been flagged as potential irritants (7). This could mean that fluoride might not be causing your perioral dermatitis.
• Changes in hormone levels due to pregnancy or taking the contraceptive pill may also cause perioral dermatitis (1).
• Physical factors such as UV light, heat, and wind can make symptoms worse too (1).

How is perioral dermatitis treated?

For mild cases of perioral dermatitis, doctors often prescribe topical treatments such as metronidazole gel or cream (10), or azelaic acid gel or cream. These help to reduce inflammation and improve the appearance of the skin over time.

If your symptoms are more severe or keep coming back, oral antibiotics like lymecycline (13) may be considered. These are commonly used in dermatology (skin medicine) to help reduce inflammation and manage bacterial triggers.

A typical dose is one capsule once daily for 8–12 weeks and generally, perioral dermatitis does not return after a course of lymecycline (13). Tetracyclines are also used to treat acne (14).

Other antibiotics that may be prescribed include doxycycline, clindamycin, or erythromycin. The exact treatment depends on your medical history and the severity of your symptoms.

What are the side effects of perioral dermatitis treatment?

Some common side effects, which may affect more than 1 in every 10 people, of tetracycline antibiotics include (14):

• More often, loose, or runny poos (diarrhoea)
• Headache
• Feeling dizzy or like you’re going to be sick (nausea)
• Being sick (vomiting)
• Swelling in the lips, tongue, eyelids, hands, or feet (angioedema)
• Spotty rash, joint pain, and sometimes tummy pain or kidney problems, caused by inflamed small blood vessels (Henoch-Schönlein purpura)
• Chest pain caused by inflamed lining of the heart (pericarditis)
• More sensitive to UV rays and light, causing a rash, redness or itching (photosensitivity reaction)
• Individuals who have lupus (long-term condition affecting the joints) may see symptoms worsen (lupus exacerbation)

You can speak to a pharmacist or doctor about the side effects of treatment. Always discuss any side effects that concern you with a healthcare professional.

Where can I get perioral dermatitis treatment?

You need a prescription from a qualified prescriber to access metronidazole, lymecycline, or higher strengths of azelaic acid.

You can request certain treatments directly through our website:

1. Select your medical condition or your preferred treatment
2. Click ‘Start my online consultation’
3. Complete the consultation, we will ask you to upload a photo of the area you wish to treat

Your consultation and photo will be reviewed by an independent UK-registered doctor, who will help determine the most appropriate treatment based on your symptoms and medical history.

If you need more help or information, or aren’t sure where to start, reach out to our Healthcare Advisors on 01295 262925, or at [email protected]. 

Where can I find out more?

1. Periorificial dermatitis [Internet]. DermNet. 2022 Jul.
2. Peri-oral dermatitis [Internet]. British Association of Dermatologists. 2023 Feb.
3. Perioral dermatitis / periocular dermatitis (syn. periorifacial dermatitis) [Internet]. Primary Care Dermatology Society. 2023 Dec 17.
4. Perioral dermatitis [Internet]. Patient. 2024 Aug 5.
5. Contact dermatitis [Internet]. Patient. 2023 Jan 30.
6. Rosacea [Internet]. British Association of Dermatologists. 2022 Apr.
7. Perioral dermatitis [Internet]. Dermatology Group of The Carolinas. 2024 Feb 2.
8. Rash Around the Mouth? Perioral Dermatitis and What It Means for You [Internet]. Colgate. 2023 Jan 9.
9. Why Use A Fluoride-Free Toothpaste? [Internet]. Colgate. 2024 Apr 30.
10. Rozex Gel [Internet]. Oxford Online Pharmacy. 2019 Jul 09.
11. Finacea [Internet]. Oxford Online Pharmacy. 2021 September 20
12. Skinoren [Internet]. Oxford Online Pharmacy. 2023 March 17
13. Lymecycline [Internet]. Oxford Online Pharmacy. 2022 Dec 23.
14. Tetracycline [Internet]. NICE (National Institute for Health and Care Excellence) BNF (British National Formulary). 2025.