Last week, I got an email from an avid Byrdie reader in response to a recent 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.
L.A. dermatologist Dr. Alan Rosenbach describes perioral dermatitis as "an eruption around the mouth that usually starts in your thirties. Sometimes it burns, but often it has no sensation. It’s most likely genetic, rather than caused by anything the patient is doing to themselves. 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.
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 practioner 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 can be caused by allergy, bacteria, fungus or virus, and 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 to do 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.
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 effective at clearing heat from the body and skin, and promoting 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.
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 have 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.
I’ve read countless medical journals on the relationship between zinc deficiency and perioral dermatitis flare-ups. In 1984, 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 is much zinc (only on a full stomach) as possible.
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. It’s not only an essential supplement to ingest, and 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.
This combo salicyclic 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 new 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 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.
Next, check out the one product that claims to stop yeast infections, UTIs, and more.