Note from the author: The response from Byrdie readers about perioral dermatitis has been incredible. I’ll continue to update this story as I discover new treatments and products that have worked for me and others. I’ll always respond to an email with “Perioral Dermatitis” in the title.
In 2019, I got an email from an avid Byrdie reader in response to a product review I wrote about Dr. Barbara Sturm’s Clarifying Line. The reader mentioned how pleased she was to hear a beauty writer discussing perioral dermatitis, and she wanted to know what other recommendations I may have for this nasty skin condition.
For me, it started with a patch. I woke up one morning during a ski trip in December and saw that one corner of my mouth looked like someone had smeared strawberry jam on it while I was sleeping. When I looked closer, I found that in addition to the redness, I had tiny white bumps around the patch, and naturally I started to freak out. I thought something grave might have been happening, so like any good hypochondriac, I turned to Google. After ruling out chickenpox and a stroke, I decided it was either eczema or perioral dermatitis.
What Is Perioral Dermatitis?
Perioral Dermatitis is a facial rash that typically causes dryness and inflammation around the corners of the mouth. The rash may also spread around the nose and eyes.
Dr. Alan Rosenbach describes perioral dermatitis as "an eruption around the mouth that usually starts in your 30s. Sometimes it burns, but often it has no sensation. It’s most likely genetic. Dermatologists believe it acts similarly to rosacea and may even be related. There are other conditions that can imitate perioral dermatitis, so it’s best to see a dermatologist to make the diagnosis.”
I waited until I was home to go to a dermatologist and see if my perioral dermatitis self-diagnosis was accurate (it was). The derm prescribed a topical steroid and an oral extended-release form of Doryx (doxycycline) to take twice a day, every day, for 90 days. The antibiotic was expensive, even with my insurance, but I ordered it anyway. The steroid cream made the patchy red skin so much worse; it actually tripled in size overnight. Steroid-gate lead to a self-imposed exile in my apartment until my skin was clearer. It felt like a scene from Home Alone, where I’d yell at a Postmate to leave the delivery outside my door so that no one had to see me. I threw out the steroid to avoid living like the Phantom of the Opera again, but I kept up with the antibiotics, and in about three weeks, it was all gone.
[Ed note: Dr. Nazarian notes that bacterial infection is not the case of perioral dermatitis and HIGH DOSE antibiotics are not needed to prescribe. Low dose anti-inflammatory doses are more appropriate for this condition.]
I was terrified of the PD coming back, so I ordered refills for an entire year. After 11 months, I had clear skin, but I was getting sick all the time. I could tell that I was building up antibiotic dependence and resistance, so I quit cold turkey and decided to go a natural route.
I’ve spent time in India and in China, and I believe in many Eastern health practices, so I turned to an alternative specialist to help with my PD. Christina Miller is the founder of Thrive Ayurveda, and a certified Ayurvedic practitioner in Santa Barbara with a Master’s degree in South Asian Religious Studies. Her knowledge of Sanskrit allows her to read from original Ayurvedic texts. “Since perioral dermatitis is a symptom rather than a standalone imbalance, it can be difficult to treat without identifying the root cause," she says. "It’s exacerbated by things like stress, anxiety and poor diet or gut health. In cases of chronic PD, we can see flare-ups more often in periods of high stress.”
I surely have regular stress, and after an entire year of antibiotics, I definitely had poor gut health. To avoid another flare-up, Miller recommended that I start by throwing away any fluoride toothpaste and doing a month-long parasite cleanse by Organic Olivia. The supplements were originally formulated for the founder to clear her chronic cystic acne and to clean out any lurking pathogenic bacteria. Luckily, the cleanse felt mild. After 30 days, my gut felt re-balanced and my skin was still clear, flare-up free, and I definitely had more energy.
[Ed note: Dr. Nazarian says there is no evidence-based medicine to support the validity of a parasite cleanse or the presence of pathogenic bacteria in anyone with perioral dermatitis.]
Then, I began exploring topical treatments and a diet to keep my PD away. Miller recommended I change to an eating protocol of cooling, anti-inflammatory foods, as well as adding herbs to support my skin and blood, which she said, “are intrinsically related.” I was desperate for my skin to stay clear, so I was game for anything. “[Your] diet should include a lot of leafy greens, broccoli sprouts, light grains such as quinoa, sourced locally and organically.” Unfortunately, with a leafier program, I also had to cut back on some of my favorites: alcohol, sugar, dairy, and processed foods.
I started with supplements. Enter: neem. I believe this has been one of the major factors, if not the main element, of keeping my skin glowing and my PD under control. “Neem is one of the single best Ayurvedic herbs for skin health," says Miller. "One of the most widely recognized and studied benefits of neem is its strong antibacterial and antimicrobial effect. In addition, it also contains analgesic properties, so it may be effective at addressing PD topically while relieving any itchiness and discomfort."
She explains that neem can be applied topically as an oil and also taken internally, in capsule form. Internally, neem is meant to clear heat from the body and skin, and promote blood health. It may help to support the immune system, which allows it to potentially address the root cause of PD, rather than just treat it symptomatically. I take two capsules a day, and have never looked back.
I’ve read countless medical journals on the relationship between zinc deficiency and perioral dermatitis flare-ups. In the 1980s, The Journal of Reproductive Medicine published a study showing that the use of oral contraceptives decreases physiologic levels of six nutrients, and one of them is zinc. Many women I’ve talked to say that their birth control caused their PD to flare-up, and zinc deficiency could be one of the reasons. I take oral birth control, so I make sure to supplement with as much zinc (only on a full stomach) as possible.
Hyaluronic acid is a naturally occurring polysaccharide found in the human body. It acts as a cushioning and lubrication agent for our joints, nerves, hair, skin, and eyes. When used in skincare, it acts as a moisture binder, which means that it will attach itself to the water in the cells (while also attracting and holding water from the air) making them plump.
This is my favorite skin repairing protectant with hyaluronic acid, and it’s lanolin-free. It’s available at almost every drugstore and is non-comedogenic (as in, it won’t clog pores). This has been a savior as an overnight treatment during times of excessive dryness and irritation related to the PD.
Back to my zinc theory. For me, it’s an essential supplement to ingest, but I’ve also found that it helps my skin topically, as well. Cleansing at nighttime during a flare-up with this has a tremendously soothing effect, and it really helps to banish the bumps.
Since I stopped taking antibiotics completely, I’ve had a couple of flare-ups—mostly during times of excessive travel, product testing, or drinking a little too much and slacking on supplements. For me, stress is definitely a contributing factor, but connecting with fellow PD sufferers helps me maintain composure without exacerbating the flare-up. Also, knowing that I have access to an effective arsenal of natural and store-bought treatments that work for me is comforting on so many levels. If you suffer from perioral dermatitis, try one of the solutions I’ve discovered for keeping mine at bay.
Zinc is an essential mineral that is needed for numerous healthy bodily functions, including boosting the immune system, healing wounds, and assisting in DNA/protein synthesis and growth. Applied topically, it's shown to aid in wound healing and regeneration, as well as protect the skin by deflecting UV rays.
This combo salicylic acid, azelaic acid, and zinc pyrithione cream was formulated by Dr. Carl Thornfeldt to treat eczema. It has worked wonders on me and my perioral dermatitis. Medical journals and studies show that topical azelaic acid is an effective treatment of PD, and I believe it.
This organic blue tansy balm is a favorite of mine, and one of the only things I can wear as a daytime moisturizer during a flare-up. Blue tansy is a newly regarded must-have for acne sufferers but for me, it really helps control redness and flaking from PD. [Ed. note: This product is also the winner of a 2019 Byrdie Eco Beauty Award.]
One of the active ingredients in this new product from Dr. Sturm is zinc. The clay cream has no fragrance whatsoever, and I noticed a difference in an active perioral dermatitis flare-up after one use of this mind-blowing mask.
Sulfur is a natural element that is an essential component for all living cells. Sulfur-based products tend to work best for mild-to-moderate acne, primarily whiteheads, blackheads, and papules.
In medical journals, topical sulfur is listed as a first-line treatment option for perioral dermatitis. The De La Cruz treatment is my favorite; I use it as a mask directly on a flare-up for up to 30 minutes, and lightly remove it with warm water. Sometimes, I dilute it with squalane oil and leave it on overnight.
Squalane (not to be confused with squalene) oil is the best moisturizer for sensitive, irritated, and—frankly—all skin types. Sqaulane is non-irritating up to its full concentration: 100 percent. Because the molecule is the same size as the skin’s own sebum, it’s able to pass through the lipid barrier more effectively. Studies suggest it has natural anti-fungal and anti-bacterial properties. I love using this as a moisturizer day and night. I swear it clears my skin faster than I can re-order it on Amazon.
Webb JL. Nutritional effects of oral contraceptive use: a review. J Reprod Med. 1980;25(4):150-156.
Lubart R, Yariv I, Fixler D, Lipovsky A. Topical hyaluronic acid facial cream with new micronized molecule technology effectively penetrates and improves facial skin quality: results from in-vitro, ex-vivo, and in-vivo (open-label) studies. J Clin Aesthet Dermatol. 2019;12(10):39-44.
Lin PH, Sermersheim M, Li H, Lee PHU, Steinberg SM, Ma J. Zinc in wound healing modulation. Nutrients. 2017;10(1):16. doi:10.3390/nu10010016
Rosso JQ. Management of papulopustular rosacea and perioral dermatitis with emphasis on iatrogenic causation or exacerbation of inflammatory facial dermatoses: use of doxycycline-modified release 40mg capsule once daily in combination with properly selected skin care as an effective therapeutic approach. J Clin Aesthet Dermatol. 2011;4(8):20-30.
Sethi A, Kaur T, Malhotra SK, Gambhir ML. Moisturizers: the slippery road. Indian J Dermatol. 2016;61(3):279-287. doi:10.4103/0019-5154.182427