Perioral dermatitis is a chronic inflammatory skin condition that typically appears as clusters of small red bumps (hard papules or pimple-like pustules) around the mouth, nose and eyes. Anyone with dark skin may find that the patches look darker than their normal skin color, rather than red. The area around the mouth is particularly vulnerable, because the skin there is thinner and exposed to constant friction and moisture from speaking, eating, cleansing and applying skincare. It is also a zone where products such as moisturizer, SPF, makeup or toothpaste can easily migrate and accumulate. At first glance, perioral dermatitis can resemble acne – which is why it’s often misdiagnosed. Acne usually involves blocked pores, blackheads and excess oil, whereas perioral dermatitis appears without blackheads and is more likely to cause burning, tightness, dryness or sensitivity rather than deep, painful spots. The bad news? Once the skin’s outermost layer, or barrier, in this area becomes compromised, inflammation can develop and cause repeated flare-ups if the triggers are not addressed. One explanation comes up again and again: we are using way too much skincare. In the quest for "perfect skin", many of us are throwing everything at our faces and hoping for the best. The problem is that modern products are often far more active – containing clinically proven compounds designed to target specific concerns – than people realize. Your daily serum likely has a combination of potent antioxidants. Your night-time retinol speeds up cell turnover. Your cleanser may contain exfoliating enzymes. A daily toner may contain acids. All of this can push the skin barrier past its limit. "The rise in perioral dermatitis cases is largely driven by these complex routines using highly concentrated actives," says Mahto. Part of the issue with finding the cause is that the reaction to products is not always immediate. With active ingredients such as retinal (a form of vitamin A), there’s often a cumulative effect: your skin barrier can be slowly weakened over weeks or months before it tips into visible inflammation. Another cause you may not expect: clean beauty. This is the case for Charlotte Palermino, writer and co-founder of skincare brand Dieux Skin. "When I was 25, I thought all my products were toxic. I started using natural products and the natural fragrances made my skin freak out. I was told my skin was ‘purging’, but really I had a horrific perioral dermatitis rash." Eventually, Palermino’s friend’s mother, a dermatologist, pulled her aside to offer some advice: "As gently as she could put it, she asked if I was in pain – I was. She wrote me a prescription for topical antibiotics, and it was the combination of topical antibiotics and sulphur that really got rid of it. Now, whenever I have a flare-up, I use the combo and it calms down. My triggers are now excessive skincare, ‘skin flooding’ or lavender oil." Palermino’s isn’t an isolated case; Dr Emma Craythorne, consultant dermatologist and chief medical officer at the skincare brand Klira, explains why clean beauty regimes often cause problems. "For years, we used parabens in skincare and understood how they behaved. But as they were pushed out by ‘clean beauty’, newer preservatives replaced them and we’re less certain how these interact with the skin. Some theories suggest they may disrupt the microbiome and contribute to conditions like perioral dermatitis." "Steroids can also play a role in perioral dermatitis, particularly topical steroids used for eczema, and inhaled steroids for asthma," says Craythorne. If you use an inhaler, she advises rinsing your mouth afterwards, and if you apply steroid creams to your body, wash your hands before touching your face. Hormones can play a role, too. "It can worsen in people with hormonal imbalances – for example, those taking medication for PCOS [polycystic ovary syndrome] or undergoing IVF or egg collection." Surprisingly, toothpaste is also a common culprit. Ingredients such as sodium lauryl sulfate (SLS), the foaming agent in many formulas, plus "strong flavourings such as mint or cinnamon oils, as well as alcohol-based mouthwashes, may also irritate sensitive skin," says Dr Alex Seijas, founder of The London Orthodontic Clinic. "Despite common concerns, fluoride is rarely the cause." Braces or aligners can subtly change how the lips sit against the teeth, increasing saliva contact, lip licking or friction around the mouth – all of which can irritate sensitive skin. And because people with orthodontic appliances tend to brush more frequently, this means that the skin is exposed to toothpaste ingredients more often. The solution is usually simple: keep brushing, but switch to a gentler, SLS-free toothpaste, rinse the skin around the lips after brushing, and don’t let foam sit on the skin. A smart tip from Hall: brush your teeth before cleansing your face so toothpaste residue isn’t left sitting on already irritated skin. Here’s the part skincare-lovers like me often struggle with: doing less may be the solution. "I advise stopping all facial cosmetics and topical products – even sunscreen – for a short time, and switching to a very mild cleanser and a bland emollient," says Craythorne. "Light gels or liquids are better than heavy creams." In practice, that means using oil-free, fragrance-free gel cleansers and simple, lightweight lotions while the skin barrier recovers. The next step? "Once the barrier settles and the inflammation, redness and bumps reduce, we can slowly introduce gentle, anti-inflammatory ingredients like azelaic acid," Mahto says. Azelaic acid may sound counterintuitive after all the advice to stop actives but, once the skin barrier has recovered, its gentle anti-inflammatory and antibacterial properties can reduce redness and spots. Other ingredients can be slowly introduced at this stage. Dr Hall recommends barrier-supporting hydrators such as ceramides, panthenol, centella asiatica (also known as cica cream), glycerine and hyaluronic acid to soothe inflammation and restore moisture. But you’ll need to wait until your skin is fully healed before reintroducing anything like retinal, tretinoin or acids. In more stubborn cases, doctors may prescribe a short course of an oral antibiotic such as doxycycline to help reduce inflammation. Nonsteroidal topical treatments such as Protopic may also be prescribed – which, in my case, is what finally cleared things up. Some supportive technologies may also help calm inflammation, but the timing matters. "Once the condition has been recognized and the inflammation is medically controlled, very gentle clinical treatments like LED can support healing because they’re calming and non-irritating," says aesthetic doctor Paris Acharya. What should we avoid during the active and healing periods? "Aggressive facials, peels, microneedling or any heat-based treatments. Perioral dermatitis is one of those conditions where doing more is usually the wrong instinct." As for lingering marks, patience is key. "Some patients are left with redness, pigmentation or slight texture changes," Acharya says. "Once the dermatitis has fully settled, these can be treated effectively – but timing is everything. Treat too early and you risk reactivating the whole process." Every expert I spoke to said that perioral dermatitis is, in many ways, a symptom of the modern beauty culture. We’ve never had more products, more online advice or more pressure to perfect our skin – yet sometimes the most radical thing is to do less. "One of the most important lessons perioral dermatitis teaches us is that healthy skin relies on balance," says Hall. "When we overwhelm the skin with too many products or powerful actives, inflammation will follow." The crucial shift to make is in how we use products: use lower strengths less frequently, and avoid layering multiple actives at once. For many, it’s not the ingredient itself that’s the issue, but the cumulative overload of irritation. It is also important to think about whose advice you follow. Skincare influencers often promote lengthy routines and multiple products, but experts urge caution. "Trust people who preach simplicity," says Palermino. "Overcomplication can feel nice, but it can also mess up your face. Boring skincare advice tends to be the most sage and results-driven." Soothe your skin: Anita’s pick of products that can help La Roche-Posay Toleriane Dermo-Cleanser, £16.50 This gentle, non-foaming cleanser is designed for sensitised skin and cleanses without disrupting or stripping the delicate barrier. Avène Tolerance Hydra-10 Hydrating Fluid, £21 My go-to for any kind of skin flare-up is this pared-back moisturiser designed for hypersensitive skin. Hyaluronic acid hydrates and thermal spring water helps to soothe irritation. It’s fragrance-free and lightweight. The Ordinary Azelaic Acid Suspension 10%, £11.10 Once the skin is fully healed, this gentle treatment can help to reduce redness and calm inflammation. Dr Jart+ Cicapair Tiger Grass Camo Drops SPF 35, £37.50 Centella asiatica (AKA cica or tiger grass) can help soothe redness thanks to its anti-inflammatory, healing properties. These lightweight drops offer a sheer hint of coverage and SPF – a breathable alternative to heavy foundation while skin recovers. Saie Slip Tint Radiant All-Over Concealer, £24 When perioral dermatitis is settling, a hydrating concealer can give light coverage without clogging or irritating the skin. This formula contains glycerine and hyaluronic acid to help draw moisture into the skin, keeping the area comfortable rather than dry or tight. Gutology Mineral Toothpaste, £16 Gentle, SLS-free and supportive of the oral microbiome, this toothpaste delivers a clean, fresh feel without harsh additives.
