Periorificial dermatitis is a common facial rash of small red or skin-coloured bumps, often with some flaking, that clusters around the "orifices" of the face - the mouth, nose, and eyes. When it sits mainly around the mouth it is usually called perioral dermatitis, which is the name most people know it by. "Periorificial" is simply the broader and more accurate term, because the same rash can appear around the nose and eyes too. It is not contagious and not dangerous, but it can be stubborn and frustrating, and it often takes several weeks to settle even with the right approach.
The rash is typically small bumps or pustules that can resemble acne, sometimes with dryness or fine scaling. A classic clue is a clear rim of normal skin right around the lips - the rash tends to spare the skin immediately bordering the mouth. It often burns, stings, or feels tight more than it itches. On lighter skin it usually looks pink or red; on deeper skin tones the bumps may be skin-coloured, or slightly lighter or darker, and the redness can be harder to see.
Periorificial dermatitis rarely has a single cause. The common thread is skin that has been exposed to something occlusive or irritating over time, or that is simply being over-treated. Frequent contributors include:
Because toothpaste foams up right around the mouth twice a day, it is a surprisingly common driver of perioral dermatitis. The usual culprits are sodium lauryl sulfate (SLS), the detergent that makes toothpaste foam, along with tartar-control, whitening, and strongly flavoured formulas. If your rash is mostly around the mouth, switching to a gentle, SLS-free toothpaste is one of the simplest things to try.
To find one, check the ingredient list for "sodium lauryl sulfate" (sometimes listed as sodium laureth sulfate) and choose a product without it. Several everyday brands make SLS-free options - for example, some Sensodyne (such as Pronamel), Hello, Verve, and Tom's of Maine formulas - but formulations change, so the reliable move is to read the label rather than trust the brand name. A plain, non-whitening, non-tartar-control toothpaste is usually the safest bet, and it is worth giving the switch a few weeks.
The guiding principle is "less is more" - much of the improvement comes from taking things away rather than adding them:
It takes patience - even with the right plan, periorificial dermatitis usually needs several weeks to clear, and it can briefly get worse before it gets better.
If the rash is not improving after you have stopped steroids and simplified your routine, if it is spreading, or if it is bothering you, it is worth having it assessed - both to confirm the diagnosis (it is easily mistaken for acne, rosacea, or eczema) and to get the right prescription treatment. Left untreated, stubborn cases can become more entrenched or shade into a rosacea-like pattern. Periorificial dermatitis is seen as a medical visit and can be assessed by referral - details on the skin conditions page.
Appointments available at Hillside Medical Clinic in Victoria and Kensington Medical Clinic in Burnaby.