An Itchy Rash Around the Lips: Perioral Dermatitis Explained

Perioral dermatitis (PD) is a scaly, itchy rash that often appears around the lips. It may extend up to the border of the mouth or there might be some clear skin in between. It may also spread to other areas of the face and body, and it can affect both children and adults.

Also called periorificial dermatitis, this condition causes symptoms such as:

• Red bumps
• Flaky skin
• Clear fluid discharge
• Inflammation
  

This article explains the causes of perioral dermatitis and what the rash looks like. It also explores how this rash is diagnosed, as well as available treatment options.

What the Rash Looks and Feels Like

PD appears as a red rash around the lips. The rash may consist of small, red bumps called papules. You may also have dry, flaky, or scaly skin and a clear fluid discharge.

The rash may itch or burn. In some cases, it can spread to other parts of the face, such as the nose and eyes. Rarely, it the same rash may appear around the genitals.

Causes of Perioral Dermatitis

The causes of perioral dermatitis are not well understood, but use of prescription steroids or some personal care products is often associated with the condition.

Females are more likely than males to develop PD. The condition is also most likely to occur in people between the ages of 19 and 45. Children can also develop PD.

Steroids

Steroids are a type of anti-inflammatory medication. Their use, especially long-term, has been closely linked to perioral dermatitis. This is true for topical steroids and for steroids that are inhaled through the nose or mouth.

If you or your child are using a steroid cream or steroid spray, especially for long periods of time, watch for symptoms of PD.

Health and Beauty Products

The use of heavy face creams and moisturizers may also cause perioral dermatitis. Those that contain certain ingredients, like paraffin and petroleum jelly, may be particularly problematic.

In children, high sun protection factor (SPF) sunscreen may contribute to this lip rash.

Makeup, especially foundation, may also cause PD.

Some cleansers and shampoos contain sodium lauryl sulfate (SLS). This compound is known to irritate sensitive skin, which may lead to perioral dermatitis.

Finally, a few case reports have suggested a link between fluoride toothpaste and PD. Tartar control ingredients used in some toothpastes may also play a role.

Other Possibilities

Researchers believe environmental conditions like heat and wind may play a role in someone developing this condition.

Other potential triggers may include:

• Oral contraceptives
• Hormone fluctuations
• Problems with the immune system
  

How Perioral Dermatitis Is Diagnosed

There is no test to diagnose PD. Your doctor can diagnose it based on your symptoms.

Seeing a dermatologist—a physician who specializes in skin conditions—may be helpful, as they may have more experience spotting cases of PD than other physicians.

Your practitioner may work to rule out other similar conditions as part of the diagnostic process. These include:

• Impetigo: This skin infection is common among school-age children and is easily spread. Symptoms include red, oozing sores around the nose or mouth.
• Seborrheic dermatitis: This rash is usually seen in the creases around your child's nose. It may cause flaking behind the ears and eyebrows
• Angular cheilitis: Iron deficiency and teeth issues can lead to inflammation and flaking at the corners of the mouth.
• Lip licker's dermatitis: Kids may suck their lower lip or lick their lips, especially during the winter. As the skin around their lips gets dry and irritated, your child may develop a rash.

Treatment Options

PD may go away on its own. If not, it's possible that discontinuing the use of triggering products may be enough to clear the rash. Use a gentle facial soap while your rash heals, and switch to dental products that do not contain fluoride.

If you use a steroid cream or spray, your doctor may recommend that you stop doing so as a first step. It's important to note that the rash may get worse before healing.

In some cases, prescription medications may be recommended.

Know, though, that PD can recur—even with treatment. You may go through periods of flare-up and periods where you have no symptoms. For some patients, long-term management of the condition may be necessary.

Prescription Medications

Your doctor may prescribe oral or topical medications to help treat your rash. These may include:

• Oral antibiotics such as doxycycline or tetracycline
• Elidel topical cream, a medication commonly used for an eczema rash
• The topical antibiotic erythromycin
• The topical antibiotic metronidazole
  

Preventing Perioral Dermatitis

If you are prone to PD and resumed using prescribed steroid medications, talk to your doctor. You may need to permanently discontinue these medications to prevent flare-ups.

You can also help prevent flare-ups by avoiding the use of heavy creams, moisturizers, and foundations.

Switching to a non-fluoride toothpaste and avoiding high SPF sunscreen may also help.

Summary

PD is a red, bumpy, flaky rash that typically shows up around the lips. It may also be found on other areas of the face and body. Children and women tend to be diagnosed most often with this rash.

While there isn't a medical test to diagnose this rash, a dermatologist will be able to identify it based on your symptoms. They may offer treatment suggestions such as:

• Taking an oral antibiotic
• Using a topical antibiotic
• Stopping the use of any steroids and/or fluoride products
  

A Word From Verywell

There is strong evidence that PD may be related to the use of prescription steroids. This includes both topical and inhaled steroids. Still, you should always talk to your doctor before changing or stopping the use of any prescription medication.

PD may take a while to clear up. It is also possible that it may recur. Talk to a dermatologist about the best treatment options for you. Working closely with your doctor will give you the best chance of successfully clearing your rash.