April 11, 2022

How I Healed My Perioral Dermatitis Naturally

Several years ago, a pesky rash on my face was diagnosed as perioral dermatitis. I do love my dermatologist, but ultimately it was through a ton of research and trial-and-error that I found a way to heal my PD. I’m sharing my experience here in the hopes that it can be of help, as I leaned heavily on the experience of others when treating my 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 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 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

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

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 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.

HERE’S HOW I HEALED 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.

The HERO products

that restored my skin barrier and healed perioral dermatitis:

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 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) and 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.

Barrier Restore Serum - healed my perioral dermatitis

From the MV website:

The key to healthy skin is water balance of the stratum corneum. This groundbreaking serum maintains barrier function in two ways.

First, it replaces NATURAL MOISTURIZING FACTOR, a collection of water soluble compounds which keep skin cells hydrated.

Secondly, it prevents loss of NMF via a liposomal sealing system that traps water molecules instead of letting them absorb into the lower layers of the epidermis.

BENEFITS

Balances moisture levels, eliminating dry, dehydrated skin.

Corrects inflammation, including acne, dermatitis and even aging.

Relieves dermatitis-related conditions (allergic and atopic), and fortifies sensitive and rosacea-prone skin.

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.

Pre + Probiotic Daily Mist

From the MV website:

Maintain skin’s microbiome balance by encouraging helpful microorganisms to thrive.

Pre-biotics feed Probiotics to keep skin’s ecosystem cycle functioning smoothly. Coconut water profoundly hydrates while anti-inflammatories calm and soothe.
BENEFITS

Balances the skin’s microbiome.

Hydrates with humectants to keep skin soft and supple.

Calms and soothes with powerful anti-inflammatories.

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!

Product image of Live Botanical Nourishing Cleansing Oil, a key to healing my perioral dermatitis

From the LB website:

Elevated with a whole herb infusion from both our garden and small farm harvested lemon balm, lavender, heal-all, rose and chamomile. Working together to deeply clean pores, calm redness, balance skin flora, and enhance protection from environmental factors.

A mild dispersing agent is added to emulsify the oil on contact with water to easily rinse and wipe away the debris from the skin using a soft cloth.  The dilution is low to ensure that it does not also dissolve your precious natural oils.

The scent is naturally derived from the herbal infusion and not distilled essential oils so it varies from batch to batch. Normally lemon balm and/or lavender is the most present.

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 never an 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.

Barrier Lipid Complex

From the MV website:

Epidermal lipids are an essential part of the skin’s stratum corneum. Therefore the most effective lipids for maintaining skin health are those most identical to the epidermal lipids: ceramides, cholesterol and fatty acids.

These lipids also make up about 50% of cell membranes, and can be damaged due to a process called lipid peroxidation, as well as exposure to internal and external stressors.

Intercellular lipid damage compromises barrier function, which can lead to transepidermal water loss. TEWL can result in dryness, irritation and wrinkles. Therefore it’s evident that lipids are an integral part of skin health, and key to a well-functioning barrier system. The essence of skin moisturizing is lipid replacement, best accomplished by applying the relevant lipids.

BENEFITS
Ceramides maintain youthful, plump, well-hydrated skin.

Cholesterol lubricates surface layers, delivering an emollient + creamy texture to moisturize profoundly, without risk of irritation or breakouts.

Biomemetic fatty acids balance skin’s oil ratio without essential oils to disrupt barrier lipid balance or threaten its microbiome.

For daytime moisturizing while battling perioral dermatitis, my go-tos I completely lucked into. I had gotten a Beauty Box from Boxwalla that contained 2 full-sized products from Votary: 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 mean things are changing, 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 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 (again, 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 always been sensitive/reactive, but apparently the hormonal roller-coaster of midlife has it off its damn rocker.

I still use the products above, but the Barrier Restore and Barrier Lipid Complex I basically just have on hand for treatment purposes when needed (when I feel my skin getting dry or dehydrated, or otherwise unhappy). You can view all of the products I’m currently using here, but I’ll also specifically share a few things I’ve found more recently that are gentle and fantabulous for protecting the skin barrier and helping skin heal from dermatitis:

SOS (Save. Our. Skin) Daily Rescue Facial Spray

TOWER 28
SOS (Save. Our. Skin) Daily Rescue Facial Spray

I thought my PD-fighting arsenal was pretty solid, so as much as I’d already come to love this brand, I didn’t immediately pull the trigger on trying this. So dumb. The glowing reviews are all well-deserved as this mist is something special. If you have any type of skin sensitivity, jump on this. You’ll see redness start to dissipate IMMEDIATELY. This has actually become my go-to the second I have any sort of issue. In fact it was one of my top picks in clean beauty for 2021! But because you have to let this dry before applying other products, I still use my trusty Pre + Probiotic spray as my hydrator mist.

Calming Moisture for Face, Neck & Scalp

CV SKINLABS
Calming Moisture for Face, Neck & Scalp

This is one moisturizer I think everyone should have in their arsenal, and a fantastic option as a moisturizer for perioral dermatitis. This is a light-feeling lotion, but boy does it hydrate. It also soothes irritated skin and calms redness. Fragrance-free and safe for the most sensitive of skin. It’s been a lifesaver for times when I can’t use anything else (like this winter with the random dermatitis), and has also been great on my teenagers’ skin when dealing with irritated acne flare-ups…hydrates without causing more acne. When I’m especially dry I’ll mix this with a facial oil, and boy does it make my face happy. And in the summer it’s perfection underneath my sunscreen.

Product image of Maya Chia Advanced Response Complex

MAYA CHIA
The Advance Response Complex Face & Neck Cream

Miracle worker. I almost didn’t try this when it launched because my skin was so reactive this winter, but I’d been hunting for something that’s great for the neck area, and the initial reviews were so fantastic. I have great luck with this line and couldn’t pass up a good deal, so I jumped in. So freaking glad I did!! Not only did it not cause a problem, I’m convinced it rebalanced my skin barrier and healed the crazy dermatitis I had going on. I’ve been using this every other night, rotating with my retinols. I wish I could afford to slather it over my entire body…not only is it healing, but I have to say my skin looks really good (dare I say, younger??). Believe the hype, this one is a hero product!

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, 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. 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, and 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.

How I healed my perioral dermatitis cleanly and repaired my skin barrier.

2 Comments

  1. […] first came across Live Botanical when I was trying to heal a bad bout of perioral dermatitis. I was on the hunt for a clean, moisturizing oil cleanser that didn’t require a […]

  2. 5 stars
    Very nice blog post. I absolutely love this website. Keep writing!

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