How I Healed My Perioral Dermatitis

Several years ago, a pesky rash on my face was diagnosed by my dermatologist as perioral dermatitis. It took some time, but through a ton of research and trial-and-error I finally found a way to heal my PD. I’m sharing my full experience here, including what did and didn’t work. I hope that it can be of help to others, because I know all too well what a frustrating experience perioral dermatitis can be.

If you’d just like a quick shopping list of clean products that help heal perioral dermatitis naturally, head to this page, otherwise read on to find out about my full experience with PD and what finally to healed it.

In this article:

• What is perioral dermatitis, and what causes it?
• Standard treatment for perioral dermatitis
• Natural remedies for perioral dermatitis
• What finally healed my perioral dermatitis
• Additional tips for treating perioral dermatitis

Every winter for several years, I would get this small, red, slightly rough rash just below my lips. It never spread, popped up in the same spot every time, and eventually it would go away. I just chalked it up to a seasonal nuisance…just some kind of random dry patch.

Then in 2018, not only did the rash reappear, but it brought along friends: I had several patches below my lips, and it began to move to my cheeks (unfortunately I don’t have pics…kicking myself for that now). Naturally, I freaked out. It didn’t matter how much I moisturized or exfoliated (I cringe now to think of the exfoliating), nothing got rid of the redness or dryness, and it continued to worsen. By the time I got to my dermatologist, it was all over both cheeks.

So was this some crazy form of perimenopausal acne? Rosacea? Fungal cooties? Turned out my little seasonal visitor was perioral dermatitis (PD). I was like, peri-whatnow? Doc prescribed a topical antibiotic, shared a few tips on things to avoid and sent me on my way.

So what is perioral dermatitis?

Perioral dermatitis is a facial rash that is usually red, dry, possibly scaly, sometimes with pus-filled bumps, can be itchy and possibly cause a burning sensation,  and usually appears on the bottom half of the face but can move to the eyelids (no bueno). It’s sometimes confused with acne or rosacea.

Causes of perioral dermatitis

Here’s the bitch of it…they really don’t know for sure what causes PD. But a few possibilities include:

• Extreme environmental factors (cold, wind, heat)
• Topical steroids
• Flouride toothpaste
• Birth control
• Hormonal imbalance (hello, perimenopause!)
• Sensitivity to anything you’re putting on your face (skincare, makeup, sunscreen)
• Soap/detergents (sulfates)
• Over-exfoliating
• Food sensitivities
• Stress

They really don’t seem to know if PD is an allergy, virus, bacterial infection or fungus. But basically what it comes down to is that something has damaged your skin barrier. The skin barrier “is our body’s natural protection against environmental stressors such as bacteria, viruses, UV light, pollution, and more. It also regulates moisture levels, helping our skin feel balanced, nourished, and healthy.”

In my case, I had created a perfect storm for dysfunction: as my skin was super dry I had stopped my retinol, but I’d started using a face scrub to get the rough stuff off, then adding various oils/creams to moisturize (but not hydrate…there’s a difference!). Throw in the loveliness that is perimenopause, and BOOM. My barrier was compromised, and my skin was pissed.

Standard treatment for perioral dermatitis

From what I can gather, my derm’s prescription of a topical antibiotic is fairly typical. And it did work…at first. But after about a week it began to get worse again, and after 2 weeks I called it quits and stopped the antibiotic cream.

The next step would’ve been an oral antibiotic, but I wasn’t willing to do that (too many bad stories on the interwebs), so I tried her other recommendation which was to kick in my retinol again (I was using a low dose Tretinoin at the time). And while that may work for some, in my case retinol and perioral dermatitis did not get along.

I’d read that an anti-fungal cream can help as an over the counter perioral dermatitis treatment, so I gave that a shot next. Same results…worked for a few days, then the PD came back with a vengeance.

The other part of treatment was removing things that could potentially be causing irritation: for me it was exfoliating, fluoride toothpaste and actives…I was already using a sulfate-free shampoo and a gentle skin cleanser (I’d switched to a moisturizing African black soap for it’s healing and anti-bacterial properties). But the PD still didn’t seem to be going anywhere (except for more places on my face). I knew it was time to do a deep dive into my skincare products and research more homeopathic options for healing perioral dermatitis. In hindsight, this clearly should have been my first move.

Treating perioral dermatitis naturally

I didn’t love using the antibiotic (or the antifungal) cream to treat my PD, but if my skin was ill, it seemed logical to use what my doctor suggested. I hate that the more natural route wasn’t my first thought, but old habits die hard. Once I really felt like my options via the doc and standard OTC products had been exhausted (other than trying the oral antibiotic), my research for natural treatment of perioral dermatitis began in earnest.

Here’s a few of the home remedies for perioral dermatitis that actually provided relief and I recommend exploring:

Probiotics

Probiotics were the first items I added into my arsenal. Almost every article I read mentioned it, and knowing that gut health effects so much I knew it couldn’t be a bad move. I initially incorporated probiotics in 2 ways: I took an oral probiotic for gut health, and I did a plain greek yogurt face mask twice a day. Applying topically helps the good microbes on your skin, providing balance and restoration. The yogurt mask is soooo soothing, and brings immediate relief. Definitely calmed the redness.

Coconut Oil

Coconut oil is well known for its antibacterial, antiviral and antifungal properties, so it was an immediate thought when I began researching. Many folks have great luck with it, for others it makes it worse (theme?). I used it as a spot treatment initially, and things started getting better. In fact I came across a lovely clean foundation/concealer that is coconut oil-based that I began using as well – I was going makeup free whenever I could, but I had a big event coming up and needed camouflage that hopefully didn’t exacerbate things. It worked well and in fact seemed to help! Initially….

Apple Cider Vinegar

You’ll see ACV come up a lot if you go down the rabbit hole of PD research. Again, many have good luck with it. Apple Cider Vinegar is antimicrobial and anti-inflammatory, and beneficial for so many things. I diluted it a bit with water and used as a toner. For me, it made areas that had the white bumps/pustules lessen, but it did nothing to get rid of the overall red patches/rashes. And it burned.

Keep in mind that perioral dermatitis is definitely not a one-size-fits-all condition, and what worked or didn’t for me might be the opposite for you (and I’m not a doctor, so this is all just based on my personal experience). But with PD I say throw the kitchen sink at it (within reason) until something helps!

What finally healed my perioral dermatitis

For several months I skated just to the edge of having my face back, only to have the PD flare up again. I’d pared my skincare routine down to bare minimum: a super basic cream (goodbye fun facial oils!), a gentle cleanser and a zinc oxide-based sunscreen. Why specifically zinc-oxide? For one, titanium dioxide and my skin don’t get along, but also there’s a ton of scoop out there about zinc oxide and perioral dermatitis: it’s a tremendous anti-inflammatory, which is one of the main reasons why it’s used in diaper cream. In fact I read several stories about folks using straight up diaper cream for their perioral dermatitis.

But since there are plenty of sunscreens out there with high concentrations of zinc, I opted to lean on one of those vs slathering diaper cream on my face. There’s a sunscreen by Kinship that has more than 22% non-nano zinc oxide, is reef safe AND has probiotics…it didn’t irritate my skin at all and I’d highly recommend it if you’re looking for a sunscreen for perioral dermatitis (I eventually moved on to something else as it has more of a dewy finish than I like, but at the time I just needed something effective that didn’t cause further irritation, and it’s terrific for that!).

Of the 3 perioral dermatitis home remedies mentioned above, the probiotics seemed to be the only thing that consistently helped, but it was only keeping the PD at bay. I was ‘treating’ the perioral dermatitis, but I wasn’t healing my skin barrier.

Let me repeat that: I wasn’t healing my skin barrier.

I received this interview in an emailed newsletter, and that’s when it clicked that I needed to change my plan of attack: rather than trying to get rid of the PD, I needed to focus on restoring my skin barrier.

1. Switched to a gentle, moisturizing OIL cleanser. Even the most gentle of cleansers can strip your skin of micro-goodies – not a big deal when your barrier is strong, but when it’s not you need something that dissolves debris while leaving your skins’ natural oils and flora intact.
2. Incorporated a hydrating serum. It’s important to remember the difference between hydrating and moisturizing – hydrating formulas bring the water to the skin, while the moisturizing formulas lock in that water.
3. Locked in the hydration with a fragrance-free, moisturizing oil in the daytime, and a gentle fragrance-free cream at night.
4. Used an amazing, deeply moisturizing oil-cream hybrid every other night, eventually a few nights per week, then as needed seasonally.
5. Drank a crap ton of water (1 gallon every day).
6. Took a Sea Buckthorn supplement (Omega-7 fatty acids, moisture).
7. Honey and Greek yogurt masks several times per week until the PD was gone.

MARIE VERONIQUE | Barrier Restore Serum

This is the product that I truly feel saved my skin. I used it morning and night on damp skin followed by a super gentle moisturizer. And once the perioral dermatitis was gone, if I got the telltale twinge that it was coming back, I spritzed on the probiotic spray (coming up next), shmeared a pump of this on and it kept the PD away. I keep this in my arsenal for times when my skin feels like it’s becoming dehydrated; it’s basically my emergency ‘kit’ for if/when my skin gets unbalanced. Truly a phenomenal product, and if you’re going to splurge on one big item to battle your PD, this one is my top recommendation.

MARIE VERONIQUE | Pre + Probiotic Daily Mist

This is a close 2nd to the Barrier Restore Serum. The calming effect on the skin is immediate, and I swear the 1-2 punch of this followed by the BRS is what not only balanced my skin but knocked out the PD. The pre and probiotics in this mist allowed me to ease off of the yogurt masks quite a bit (which at the height of my PD meant twice a day…a bit tedious after a while!). I still use this almost daily, it’s a great hydrator, and fantastic for calming any sort of irritation.

LIVE BOTANICAL | Nourishing Cleansing Oil

My friends, this is the best oil cleanser on the market and definitely one of the key elements to recovering my skin barrier. I’ve fangirled the hell out of this product…I’m sure they’re sick of me on their IG! Oil cleansing has become mainstream, but many times you have to do a double-cleanse (basically, use the oil to remove heavy makeup, sunscreen, etc., then use a liquid/gel/bar cleanser to remove the oil cleanser). But if you’re skin is dehydrated, dry, sensitive and/or otherwise compromised, going in with that 2nd cleanser defeats the moisturizing effects of the oil that you so badly need and strips your skin of the micro-goodies we need to keep for regaining balance. So the key was finding an oil cleanser that rinses clean without the need for a double-cleanse. And this one does it! Gets all of the makeup and sunscreen off of your skin, but rinses clean on its own while leaving your skin moisturized, never stripped. It’s the best. And you only need 2 squirts (3 if heavy beach sunscreen is onboard), so a bottle lasts a long time. No irritation, safe for the most sensitive…it’s just a fantastic oil cleanser. And I deem it the best cleanser for perioral dermatitis!

‘HAPPYMEDIUM’ saves you 20%!

MARIE VERONIQUE | Barrier Lipid Complex

Never have I been so brand-focused as I was when I was kicking the crap out of PD. Yes, I also splurged on the Barrier Lipid Complex (thank goodness for various sales/promos!). I couldn’t help myself after reading about it and sorting through a ton of reviews. And it’s pretty amazing. I used a small amount – more like 1/4-1/3 of the dropper – every other night (it’s so rich I was initially worried it would cause an acne break-out, but luckily a non-issue!). It truly has a magical hydrating and moisturizing effect…I’ve never experienced another product like it. I will say that it does not smell great, but the scent fades quickly, and I only use it at night anyway or as a mask mixed in with honey and/or yogurt. I still love and use this, particularly in the winter when I get really dry. My skin always feels so healthy the next morning…love this product.

For daytime moisturizing while battling perioral dermatitis, my go-tos were CV Skinlabs’ Calming Moisture and a knock-out duo from Votary that I completely lucked into via a Beauty Box from Boxwalla: Super Seed Facial Oil and Superseed Nutrient Cream. Best $50 spent as it turns out. The cream is luscious, fragrance-free, super moisturizing and extremely gentle (the texture reminded me of how I remember my Nana’s cold cream). I used it every night while my skin was healing. Likewise the oil was fragrance free, non-irritating, moisturizing and gentle. In fact it was literally the only facial oil I could use for a long time (luckily it was a giant bottle!). The only reason I won’t spotlight them here is that sadly there are currently no US stockists (but if you’re in the UK, grab them!). Just remember, the key to the best perioral dermatitis moisturizer is one that is fragrance-free, no essential oils, with good fatty acids.

How things are going now

And what do things look like now? Well, things had been going great until I had a crazy bout of some other kind of facial dermatitis this past winter, and it was definitely about hydration (or lack thereof). The joys of menopause bring lots of changes, and I needed to tweak my routine AGAIN. But once I got my barrier back in line all was well.

I don’t manually exfoliate my face now…ever. I occasionally will use a muslin cloth with my oil cleanser, but that’s rare and NOT in the winter when my skin is more sensitive than usual. I’m convinced that over-exfoliating was one of the primary reasons that my barrier was compromised, and consequently the explosion of perioral dermatitis.

I can use all of my facial oils again, and I am back to using a retinol…Altreno is a more moisturizing Tret, and I alternate with a plant-based retinol that’s really gentle. I can use a vitamin C serum (Maya Chia’s…so good, aimed at those with sensitive skin issues, and the firming effect is fab), but I don’t use it daily. I still typically avoid essential oils in my face products as it seems to be a trigger. I’m also careful about introducing or trying new skincare products. My skin has long been sensitive/reactive, but apparently the hormonal roller-coaster of midlife has it off its damn rocker.

I still use all of my hero products above, but the Barrier Restore and Barrier Lipid Complex I basically keep on hand for treatment purposes when needed (when I feel my skin getting dry or dehydrated, or otherwise unhappy). You can view the products I’m currently using here, but I’ve also compiled my comprehensive list of the best skin care products for crazy sensitive skin…everything mentioned are products I’ve used long term, so they are truly vetted!

Additional tips for dealing with perioral dermatitis

• The KISS principle needs to be in effect if you’re riding the PD express – the easiest way to weed out anything that can worsen your bout of PD is to get down to basics when it comes to products and even diet.
• Use a bare minimum of face products: hydrator, moisturizer, oil cleanser, zinc oxide-based sunscreen (if needed).
• Go without makeup. I know, it sucks, but if you can concentrate on getting your skin barrier repaired quickly, hopefully this doesn’t have to last too long. I promise it really makes things heal quicker.
• Don’t use anything with essential oils in it. And remember, “all-natural” doesn’t mean all-good when it comes to your skin. Plenty of natural things are irritating. Use fragrance-free products that have very few, very simple ingredients.
• Make sure your hair products are sulfate-free.
• Be gentle when you wash your skin, preferably using just your hands. I HIGHLY recommend an oil cleanser, and one you don’t have to double-cleanse.
• De-stress. Stress and perioral dermatitis feed each other…get your meditation on, read a book, go for a run…whatever you do to unwind, do that.
• Give it time. I know it’s hard to not use all of the fun products and your usual anti-aging arsenal, but let your skin completely heal before SLOWLY introducing those products back in.

YMMV:

• I do think apple cider vinegar and coconut oil can be helpful. But ultimately if you’re working on your skin barrier, I’d say possibly only needed for the initial flare up.
• I don’t think flouride toothpaste ever caused me any issue (and I went back to using it pretty quickly). But plenty say making the switch really helped.
• African black soap was mentioned often when I was doing my research, and I did use and love the Black Clay Facial Soap from Osmia. It is very gentle, and again, seemed to help initially. Though ultimately I needed something even more moisturizing to get my skin barrier healed, and switching to an oil-based cleanser really boosted healing. It’s a bit of a juggling act, finding the balance of treating the PD and repairing the skin barrier…. IMHO it’s definitely worth trying african black soap as a perioral dermatitis cleanser for its healing qualities, but perhaps alternate it with the oil cleanser.

I sincerely hope my experience and these ramblings can help. And while I’d love to think that my time with perioral dermatitis is done I’m sure it will rear its ugly head again…I’ll be sure and post any updates here. Please reach out and comment below if you have any questions, or to share anything you’ve found helpful in healing perioral dermatitis.

EDITED TO ADD: I’ve created a quick-and-easy list of products that either directly aid in the healing of perioral dermatitis or are simply safe to use while riding the PD roller coaster.