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 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)
- Food sensitivities
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 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, and I gave that a shot. 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 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. I’m working on it. 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.
I’ll share a few of the home remedies for perioral dermatitis that I tried that I think are worth exploring:
Probiotics were the first items I added into my arsenal. Almost every article I read mentioned it, and we know that gut health effects so much so I knew it couldn’t be a bad move. I initially incorporated probiotics in 2 ways: I took an oral probiotic, 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 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.