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When I first started writing about skin, a friend reached out to me to ask about a skin condition that she had been diagnosed with years ago: perioral dermatitis.
Admittedly, my knowledge of perioral dermatitis was quite shallow, and as I began to research it, it seems that there isn’t a whole lot that is known about it. Fortunately, it is a highly treatable condition that seems to overlap to a degree with rosacea (earning it the earlier name of “steroid rosacea”) and even seborrheic dermatitis.
What is Perioral Dermatitis
Perioral dermatitis (PD) is a chronic, recurrant inflammatory disease that most commonly occurs in the perioral region of the face (the area around the mouth). It can also affect the area around the nose, and in roughly 20% of cases, it can manifest around the eyes (though it goes by another name if around the eyes: peri-orificial dermatitis).
It afflicts around 1% of the population of the United States, particularly those with fair skin, and predominately occurs in women between 18-45, with 20s and 30s having peak incidence.
It presents as small, red, tender, sometimes itchy bumps that can flake and burn. While commonly mistaken for acne, it is distinct from acne in that it only presents in specific locations, spares the small area around the lips, and lacks pustules (whiteheads).
Causes of Perioral Dermatitis
The causes of perioral dermatitis are unclear. It is a relatively “young” disease that was only first described as a distinct condition in 1964. It is first and foremost an inflammatory condition, and is aggravated by ingredients and habits that can create inflammation either in the skin or in the body.
While I was researching PD, the one constant that showed up again and again is that it is aggravated by corticosteroid use — both topical and inhaled. To specify, that means not just creams like kenalog, triamcinolone, and over-the-counter hydrocortisone, but also asthma inhalers (including Advair, Flovent, and ProAir aka Albuterol) and nasal allergy mists like Beconase, Flonase, Nasonex, Omnaris, and Veramyst.
Less commonly, but still a factor to consider are hormones, where monthly shifts can put the condition into overdrive. More frustrating is that oral contraceptives can worsen PD in some.
Other causes can be fluoridated toothpaste, high SPF value sunscreens¹, sunscreens with the filters zinc oxide and titanium dioxide, the ingredient “isopropyl myristate,” improperly removing makeup or sleeping in makeup, occlusive ointments (Vaseline, Aquaphor, and oils, for example), heavy creams with occlusive ingredients, and cold creams (wipe-off cleansing creams that leave a residue, like Pond’s). In one case, a woman’s favorite lip balm (containing the ingredient propyl gallate) caused her PD.⁶
Treatment
PD can look like many other conditions, such as acne, angular cheilitis, rosacea, or seborrheic dermatitis, and requires treatment of a professional due to the inflammatory nature of the condition.
The most important thing for anyone suffering from PD is to discontinue steroid use – whether cold-turkey or weened off with the management of a healthcare professional. While topical steroids can seem to improve the condition, they frequently create a rebound effect, which can make the condition worse.
Once steroids are removed, the skin will get worse before getting better. This is the toughest part of PD for most people. Topical antibiotics or topical immunosuppresants (such as Pimecrolimus or Elidel) are frequently prescribed due to their tremendously helpful anti-inflammatory effects on PD, and azelaic acid can prove useful in some cases. In very severe cases, oral antibiotics can be prescribed in addition to topicals.
While healing from PD, the skin should not be cleansed with any cleanser, and makeup and skincare products should be avoided completely until the condition resolves. And no matter how tempting, PD should never be scrubbed, as this worsens the inflammation.
Once treated, it is encouraged to use liquid or gel sunscreens as well as soap-free cleansers that do not dry out the skin, as TEWL (trans-epidermal water loss) is significant in people who suffer from PD.
Long-Term Care
Some people have PD once in their lives, while others may combat it on and off for several years. If you fall into the latter, it is important to try to avoid triggers that can cause the condition to reoccur (particularly steroid use). That means cleansing your skin each day with gentle cleansers, always removing makeup (removing it with a wipe does NOT count – you need to cleanse it away thoroughly with an oil cleanser that rinses cleanly), and using light products, particularly around the areas typically affected.
Prescriptions like azelaic acid and over-the-counter .1% adapalene (Differin)² may also help to manage the condition in the long-term.
I’ve put together a list below of some cleansers and moisturizers that are recommended for people suffering from PD. Again, like with my rosacea list, this is not a be-all-end-all list.
None of the products listed contain isopropyl myristate or heavy occlusive ingredients.
Recommended Products
Creamy Cleansers
CeraVe Hydrating Cleanser
Ingredients: Purified Water, Glycerin, Behentrimonium Methosulfate and Cetearyl Alcohol, Ceramide 3, Ceramide 6-II, Ceramide 1, Hyaluronic Acid, Cholesterol, Polyoxyl 40 Stearate, Glyceryl Monostearate, Stearyl Alcohol, Polysorbate 20, Potassium Phosphate, Dipotassium Phosphate, Sodium Lauroyl Lactylate, Cetyl Alcohol, Disodium EDTA, Phytosphingosine, Methylparaben, Propylparaben, Carbomer, Xanthan Gum.
Aquanil
Ingredients: Purified Water, Glycerin, Cetyl Alcohol, Benzyl Alcohol, Sodium Laureth Sulfate, Stearyl Alcohol and Xanthan Gum.
La Roche-Posay Toleriane Hydrating Gentle Face Cleanser
Ingredients: Aqua/Water/Eau (La Roche-Posay Prebiotic Thermal Water), Glycerin, Pentaerythrityl Tetraethylhexanoate, Propylene Glycol, Ammonium Polyacryloyldimethyl Taurate, Polysorbate 60, Ceramide NP, Niacinamide, Sodium Chloride, Coco-Betaine, Disodium EDTA, Caprylyl Glycol, Panthenol, T-Butyl Alcohol, Tocopherol.
La Roche-Posay Toleriane Dermo Cleanser
Ingredients: Wate/Aqua, Ethylhexyl Palmitate, Glycerin, Dipropylene Glycol, Carbomer, Sodium Hydroxide, Capryl Glycol/Caprylyl Glycol, Ethylhexylglycerin.
Avene Extremely Gentle Cleanser Lotion
Ingredients: Avene Thermal Spring Water (avene Aqua), Cetearyl Alcohol, Serine, Cetrimonium Bromide, Coco-Glucoside, Dipotassium Phosphate, Disodium Edta, Disodium Phosphate, O-Phenylphenol, Sodium Cetearyl Sulfate, Water (Aqua).
Spectro Jel Cleanser for Blemish-Prone Skin – Fragrance Free
Ingredients: Aqua, Butylene Glycol, Glycerin, Hydroxypropyl Methocellulose, Polysorbate 20, Cetyl Alcohol (moisturizer), Hydrated Silica, PEG-12 Dimethicone, Diazolidinyl Urea, Carbomer, Triethanolamine, Sorbitan Oleate.
Foaming Cleansers
CeraVe Foaming Cleanser
Ingredients: Purified Water, Cocamidopropyl Hydroxysultaine, Glycerin, Sodium Lauroyl Sarcosinate, PEG-150 Pentaerythrityl Terastearate, PEG-6 Caprylic/Capric, Glycerides, Niacinamide, Propylene Glycol, Sodium Methyl Cocoyl Taurate, Ceramide 3, Ceramide 6-II, Ceramide I, Hyaluronic Acid, Cholesterol, Sodium Chloride, Phytosphingosine, Citric Acid, Edetate Disodium, Dihydrate, Sodium, Lauroyl Lactylate, Methylparaben, Propylparaben, Carbomer, Xanthan Gum.
Olay Foaming Face Wash Sensitive
Ingredients: Water/Eau, Glycerin, Sodium Myristoyl Sarcosinate, PEG-120 Methyl Glucose Dioleate, Sodium Lauroamphoacetate, Aloe Barbadensis Leaf Juice, Polyquaternium-10, PEG-150 Pentaerythrityl Tetrastearate, Glycol Distearate, Sodium Laureth Sulfate, Cocamide MEA, Laureth-10, Disodium Lauroamphodiacetate, Sodium Trideceth Sulfate, Citric Acid, Disodium EDTA, Phenoxyethanol, DMDM Hydantoin.
La Roche-Posay Toleriane Purifying Foaming Cleanser
Ingredients: Aqua/Water/Eau (La Roche-Posay Prebiotic Thermal Water), Glycerin, Coco-Betaine, Propylene Glycol, Sodium Cocoyl Glycinate, PEG-120 Methyl Glucoside Dioleate, Sodium Chloride, Ceramide NP, Niacinamide, Sodium Hydroxide, Disodium EDTA, Capryloyl Glycine, Caprylyl Glycol, Citric Acid, Acrylates Copolymer.
Makeup Removers
Clinique Take the Day Off Cleansing Balm
Ingredients: Ethylhexyl Palmitate, Carthamus Tinctorius (Safflower) Seed Oil, Caprylic / Capric Triglyceride, Sorbeth-30 Tetraoleate, Polyethylene, PEG-5 Glyceryl Triisostearate, Water / Aqua / Eau, Tocopherol, Phenoxyethanol.
Kose Softymo Speedy Cleansing Oil
Ingredients: Mineral Oil, PEG-8 Glyceryl Isostearate, Cetyl Ethylhexanoate, Cyclomethicone, Water, Simmondsia Chinensis (Jojoba) Seed Oil, Isostearic Acid, Glycerin, Phenoexyethanol.
Moisturizers
CeraVe PM Facial Moisturizing Lotion
Ingredients: Purified Water, Glycerin, Caprylic/Capric Triglycerides, Niacinamide, Cetearyl Alcohol, Ceramide 3, Ceramide 6-II, Ceramide 1, Phytosphingosine, Hyaluronic Acid, Sodium Hydroxide, Dimethicone, Behentrimonium Methosulfate, Ceteareth-20, Polyglyceryl-3 Diisostearate, Cholesterol, Xanthan Gum, Carbomer, Disodium EDTA, Dipotassium Phosphate, Potassium Phosphate, Sodium Lauroyl Lactylate, Methylparaben, Propylparaben.
CeraVe Daily Moisturizing Lotion
Ingredients: Purified Water, Glycerin, Caprylic/Capric Triglyceride, Behentrimonium Methosulfate and Cetearyl Alcohol, Ceteareth-20 and Cetearyl alcohol, Cetyl Alcohol, Polyglyceryl-3-Diisosterate, Dimethicone, Hyaluronic Acid, Ceramide 1, Ceramide 3, Ceramide 6-II, Cholesterol, Phytosphingosine, Potassium Phosphate, Dipotassium phosphate, Methylparaben, Propylparaben, Disodium EDTA, Sodium Lauroyl Lactylate, Polysorbate 20, Carbomer, Xanthan Gum.
CeraVe Baby Moisturizing Lotion
Ingredients: Active – Dimethicone, 1%. Inactive – Purified Water, Caprylic/Capric Triglyceride, Cetostearyl Alcohol, Cetyl Alcohol, Emulsifying Wax, Niacinamide, Ceramide 3, Ceramide 6-II, Ceramide 1, Hyaluronic Acid, Allantoin, Tocopheryl Acetate, Lauric Acid, Zinc Citrate, Polygylceryl-3 Diisotearate, Behentrimonium Methosulfate, Sodium Lauroyl Lactylate, Arginine PCA, Potassium Phosphate, Dipotassium Phosphate, EDTA, Sodium PCA, Phytosphingosine, Cholesterol, Xanthan Gum, Carbomer.
La Roche-Posay Toleraine Facial Fluid
Ingredients: Aqua/Water, Squalane, Glycerin, Dipropylene Glycol, Sodium Carbomer, Ethylhexyloxyglycerin/Ethylhexyglycerin, Capryl Glycol/Caprylyl Glycol.
EltaMD PM Therapy Facial Moisturizer
Ingredients: Purified Water, Ethylhexyl Isononanoate, Niacinamide, Glyceryl Stearate, PEG-100 Stearate, Hydroxyethyl Acrylate/ Sodium Acryloyl Dimethyl Taurate Copolymer, Hydrolyzed Rice Protein, Linoleic Acid, 1-3-Bis (N-2-(Hydroxyethyl) Palmitoylamino) -2- Hydroxy Propane, C10-30 Cholesterol/Lanosterol Esters, Sodium Hyaluronate, Glycereth-26, Cetearyl Glucoside, Thioctic Acid, Distearyldimonium Chloride, Tocopheryl Acetate, Xanthan Gum, Oleth-3 Phosphate, Butylene Glycol, Phenoxyethanol, Iodopropynyl Butylcarbamate, Disodium EDTA, Sodium Bisulfite, Sodium Hydroxide.
Sources
- Physical sunscreens with high sun protection factor may cause perioral dermatitis in children
- Perioral dermatitis successfully treated with topical adapalene
- Perioral dermatitis
- The Treatment of Perioral Dermatitis, Acne Rosacea, and Seborrheic Dermatitis
- Guideline: Perioral dermatitis
- Lip and Perioral Dermatitis Caused by Propyl Gallate
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