Bumps and redness around the mouth? Is it a Breakout or Something Else? Decoding Perioral Dermatitis

🔍 What Exactly Is Perioral Dermatitis (POD)?

POD is an inflammatory skin rash that primarily affects the skin around the mouth (perioral means "around the mouth"). Sometimes it can pop up around the nose (perinasal) or even the eyes (periocular). POD is more common in females and those with a history of childhood eczema. I also commonly see that those with PD will often have other conditions, such as gut issues, asthma, hay fever and other allergies in their history too.

What does it look like?

• Small, often pink or red bumps (papules) and sometimes tiny, pus-filled spots (pustules).
• Persistent redness and mild flaking or scaling.
• The key identifying feature: It often leaves a clear, narrow ring of normal skin right around the border of the lips.
• It can feel itchy, tight, or burning, unlike typical acne which is often just tender.

The important distinction: It is NOT traditional acne. While it looks like breakouts, the underlying cause is different, and treating it like acne (with scrubs or high-strength acids) usually makes it worse. It can sometimes be mistaken for rosacea too.

💥 Why Me? Common Triggers for POD

The exact cause of POD isn't always cut and dry, it's complex and often involves a mix of factors, but it’s essentially an inflammatory reaction that has been linked to gut health and hormonal factors.

Here are the most common things that can trigger or worsen a flare:

• Topical steroid creams used for a different rash can trigger a severe POD flare when stopped, as the skin becomes "addicted" to the anti-inflammatory effect
• Heavy, occlusive products on skin such as vaseline, rich ointments and balms can clog the hair follicles and trap heat/bacteria, creating the perfect inflammatory environment
• Toothpaste and Cosmetics such as foaming cleansers, shampoos, and cleansing wipes. Avoid fragranced and essential oil-based skincare in the area. These all can create irritation from the ingredients
• Makeup: Foundation and primers can make the condition worse again by irritating the skin or creating a physical blockage. If you can't go without makeup, try your best to limit how often you wear it and gently cleanse off as soon as you get home. I recommend a mineral-based foundation such as Issada CC8 Cream or 1Skin Treatment Foundation
• Face Masks: Wearing face masks is essential in many workplaces, and unfortunalty, they can aggravate via friction and trapping heat/bacteria
• Hormonal Changes: Common during pregnancy and peri-menopause where the skin begins to dry out more. 
• Stress: Flare-ups often occur when your workload or stress levels are chronically high.

🛑 The POD Treatment Philosophy: Less is More

Since POD is often a response to irritation or product overuse, the first and most critical step in treatment is often “The Zero Therapy.”

1. Stop the Offender(s) Immediately: See above for any you think may be contributing. If you are using any topical steroid on your face, seek medical advice first if plan to stop, as you need a plan for managing the rebound). Ditch all heavy occlusive creams and any products with strong fragrances.
2. Strip Back Your Routine: For two weeks, use only fragrance-free, soothing products. I recommend just a gentle, non-foaming cleanser (such as Larimedical Premiere Milk Cleanser), a water-based moisturiser (such as Epicure Oil-Control Hydrator) and a hat when outside (or this sunscreen if needed - Airyday Pretty In Zinc). Your goal is to simplify, soothe, and avoid irritation
3. Check Your Toothpaste: Try switching to a non-fluoridated toothpaste and be meticulous about avoiding it on the lips and wiping your mouth after brushing

🎯 My Balanced Treatment Plan

Once you've simplified your skincare routine, we can introduce targeted treatments to calm the inflammation and clear the bumps:

• Prescription: Often, POD requires a doctor's help. Your GP or dermatologist may prescribe topical and/or oral antibiotics (often low-dose Doxycycline) to completely clear a stubborn flare.
• The Dermal Therapist's Role: As a Dermal Therapist, I focus on preventing flare-ups and supporting the skin during recovery:
• Azelaic Acid: This superstar ingredient is fantastic for POD. It's anti-inflammatory, targets redness, and gently exfoliates without irritation.
• LED Light Therapy is a powerfully anti-inflammatory and soothing treatment. Helps to repair the skin barrier and calm the angry redness without using any heat or harsh chemicals.
• Barrier Support: Gentle, in-clinic treatments focused on infusing ingredients like Ceramides and Niacinamide to rebuild the skin's resilience.
• Skin Needling: When skin is not in a flare, needling can help rebuild the skin structure and function to become more resilient 
• How a Naturopath Can Assist: A naturopath can address the internal inflammatory triggers:
• They may investigate and treat gut health and hormonal issues, which are often linked to PD flares.
• They might recommend Zinc or Omega-3 fatty acids to reduce overall inflammation in the body.

A Final Note from Me...

I get how frustrating and lonely it can feel sometimes when dealing with a chronic skin condition, and part of my role is helping you navigate all the evidence-based, effective treatments and advice. Perioral Dermatitis can feel disheartening, but it is manageable. The key is to seek support and be patient, gentle, and consistent, then you will see that ring around your mouth return to smooth, happy skin.

You've got this! ✨