I had good skin my entire life. Not model-off-duty skin and not I-can-afford-fancy-treatments skin, per se. It didn’t glow like Kerry Washington’s or shine like I was perpetually post-facial – but it was healthy and clear, and it did me well.
I got the occasional whiteheads and had small breakouts around, but the overall picture was one of a calm and happy organ (your skin is an organ, lest you forget).
Then one day it changed completely, never to return to its former self. I developed a condition called perioral dermatitis at the same time I began birth control. Over one year and way-too-many medications later, I still haven’t figured out how to slay the beast that is perioral dermatitis.
What is perioral dermatitis, you ask? If those two words are new to you, or if you suffer from the same condition, read on for my personal experience with PD—what’s worked, what hasn’t, and why it’s the most frustrating problem ever.
Two months after beginning a new course of birth control (I had been BC-free for five years), I started noticing a recurring blemish on the right side of my mouth between lips and nose. In dermatology, the skin areas on either side of your mouth are referred to as your perioral folds.
It was red and scalier than usual zits, but I thought it was your standard acne-related blemish. It would appear, hang out for a few days, then disappear. The weirdest part was that it always came back in the same exact spot. I thought it was odd that I kept getting the same single blemish in the same spot, but figured the area was just super irritated (I am majorly guilty of picking).
Then, to my horror, it started to spread. I developed a similar type of legion on the left side of my mouth, then the middle and bottom of my chin, and eventually around the sides of my nose and eyes. It was a combination of red and pink bumps that truly looked like regular old acne, and more patchy pink and red areas that looked like a rash. I later learned that the red and inflamed rash-like legions are referred to as “papules,” when a dermatologist would inspect my chin and mouth, taking count of my papules (I had 7).
Eight months after dealing with what I had assumed was adult-onset acne, I finally figured out, via Google, that I had perioral dermatitis. I had been attempting to self-treat throughout the duration of the problem in the following ways: I had changed my diet, tried apple cider vinegar masks, washed and moisturized with coconut oil, applied punctured vitamin E capsules, and adopted new exfoliating toners. I had been continuing to use my prescription retinol cream during those eight months because I thought it would help the issue by turning cells over and combating bacteria and zits. I had no idea what I was up against.
Finally that morning eight months in, I woke up with the sides of my mouth and chin more inflamed, red, and irritated than ever before. It looked worse than it had ever in my life and felt like there was something really wrong. I knew then and there that this wasn’t just “problem skin” – the bumps and patch-like regions had evolved over the months and it was clear I wasn’t facing acne. I think my actual search terms were “red patch skin and bumps around mouth” and couldn’t believe what I saw and read – stories and pictures of people with exactly what I had.
Though I knew it to be the case as soon as I saw those first pictures of people with perioral dermatitis, the dermatologist confirmed that I had the nasty problem.
What I learned, both from the dermatologist and a lot of research is that PD is shockingly common. It’s extremely common in women ages 20 to 45 – women of childbearing years who are often on birth control. Although, no one knows exactly why or how it happens, just that it generally has to do with hormonal changes (which birth control induces), as well as the use of topical steroids and common ingredients in shampoos, cosmetics, and dental products, such as parabens, sulfates, and fluoride.
Its commonness was astounding to me as I had never so much as heard the words “perioral dermatitis” or seen them in print until the day I found myself self-diagnosing over the internet. I’d never seen a single article in a health or beauty magazine about women facing perioral dermatitis, or even just a mention – a blurb, a paragraph, something.
Its commonness was astounding to me as I had never so much as heard the words 'perioral dermatitis' or seen them in print until the day I found myself self-diagnosing over the internet.
The first dermatologist I saw put me on an immediate 30-day course of doxycycline, as well as two topicals to incorporate into my skincare routine. In medical dermatology, PD is most commonly treated with antibiotics and prescription topicals. I tried generic doxy in conjunction with Metrogel in the mornings and Ziana gel at night. After a month of antibiotics, my papules had decreased in size and irritation by about 60 percent, but the antibiotics were so hard to tolerate. I have a sensitive stomach, and sensitive system, and they completely wiped me out (stomach aches, headaches, fatigue, you name it). I barely made it through the 30 days, and within three days of stopping, the problem started up again.
Over the next five months, I was on and off three additional types of antibiotics – all of which were difficult to tolerate – and washing and moisturizing with sulfur solutions. The PD only ever reduced for so long as I was taking the pills, and came back immediately upon finishing a course. One of the antibiotics even made me full-on depressed, a side effect which went away as soon as I ceased treatment. I kept thinking: what am I supposed to do, take antibiotics forever?
One of the antibiotics even made me full-on depressed, a side effect which went away as soon as I ceased treatment.
What’s worse, the irritation and inflammation had actually reached an all-time high. My skin was constantly dry, itchy, and painful. It was uncomfortable every second of every day.
I finally decided that I could no longer take antibiotics. It just wasn’t an option. They wreaked havoc on my body and life and didn’t even make the PD go away.
I saw a new dermatologist (the third that I’ve seen for PD), who assessed my entire lifestyle and decided our action plan was going to be telling me what not to do.
He told me to stop washing with sulfur and stop using all lotions, creams, and moisturizers immediately. I was not to take hot showers or long showers, and no baths, period. I was not to use my Clarisonic on the area as I had been, and I was not to touch my face (except during washing). In the mornings, I would wash with water only – lukewarm – and at night, I’d wash with a gentle cleanser. No pads, washcloths, sponges, loofahs, or brushes. Nothing but the soft pads of my fingertips.
It was a super simple, gentle routine meant to calm my skin down from its extreme state of irritation during the five months I was on antibiotics and topicals.
By the time I saw this dermatologist, my original two papules (the PD legions that had started it all – on the right and left sides of my mouth) had experienced such trauma that they were hyperpigmented from the irritation – which is to say a deep, dark brown color.
This dermatologist also told me that if I had still been on birth control he would have told me to stop it immediately. I wasn’t, since I had stopped after three months due to other side effects, but ten months after stopping I was still suffering from perioral dermatitis.
At the time of writing this article, it has been exactly five weeks since I began the “no” regime for my skin – basically doing nothing except splashing with lukewarm water when I wake up and using Cetaphil Gentle Skin Cleanser ($11) at night.
I don’t use a single serum, cream, toner, primer, retinol, or exfoliator. I still use makeup (though I try to go as long as possible without it), because my dermatologist says makeup is considered “neutral” for perioral dermatitis. Most moisturizers and products with harsh ingredients will actively exacerbate and make it worse, but makeup itself is neutral.
My overall redness and irritation have gone down significantly, but I still wake up every single morning with new red bumps. Sometimes there are five, sometimes there are seven, and sometimes there are three times that. This morning, I woke up with a patch of eleven new red bumps on my chin, three on my right perioral fold, and four on my left. I am so sick and tired of my face looking and feeling this way and have no idea what to do anymore except continue being gentle.
A few patterns I’ve noticed: drinking hot coffee makes it worse, toothpaste with sodium lauryl sulfate definitely makes it worse, and spray tans seem to bring on an outbreak (I am guessing due to chemicals).
I have read about all kinds of natural topicals for PD: from calendula cream to acacia honey, tea tree oil, and black clay. I would love to think there is some magical ingredient out there that holds the key to restoring the health of my skin – something that will balance the irritation and banish the clustered red bumps for good. I want to experiment, but the truth is that the state of my skin hangs in such a tenuous balance that I’m too scared to try applying tea tree oil, or diaper rash cream. I can’t risk an aggressive adverse reaction. My skin feels so delicate at the moment that my morning water-wash is about all it can take.
One thing is certain: I should have seen a dermatologist way, way earlier in the process. I see women in the elevator in my building sometimes, or on the street, and I can tell they have perioral dermatitis. I can spot it like a pro; I know exactly what it looks like. The scary and complicated part is that it looks a lot like your typical run-of-the-mill breakout and “bad skin.” So much so that it was possible for me to believe I was dealing with acne for eight months before seeing a professional.
The scary and complicated part is that it looks a lot like your typical run-of-the-mill breakout and 'bad skin.'
And I wonder if, based on my own experience, they think it’s acne and are treating it as such.
The worst part about PD is that the products we use to treat acne make it worse. Things like benzoyl peroxide and salicylic acid only inflame and hurt PD. I wanted to write about PD because there is so little out there, and yet so many women are suffering from it, and may not even realize they have it.
The last 14 months have been frustrating, painful, and expensive as I’ve purchased and wasted products trying to heal my skin and seen three different medical professionals. I hope my own experience can help someone out there who maybe woke up one day with skin that has transformed for the worse, and doesn’t know why. And hey, maybe one of you out there has the key to this confusing problem. For now, I just keep hoping that one day it will disappear as suddenly as it showed up. And thank god I can still wear makeup.
Have you heard of PD before? Have any of you experienced it? Has anything worked or not worked? Please sound off in the comments!