Perioral dermatitis: signs, causes and treatment

Perioral dermatitis is a rash of small, acne-like bumps that usually sits around the mouth and can also appear around the nose or eyes. It is common, it does not spread to other people, and steroid creams are linked to it more than to any other trigger. A doctor diagnoses it, and treatment starts with stopping steroid creams on the face. This guide covers its signs, its known triggers, how it differs from acne, and what to expect from treatment. It is part of Skinli's guide to acne by face area.

Skinli gives general education and is not a doctor. This page gives no medicine and no dose, because perioral dermatitis needs a doctor to confirm it and choose the treatment. Acne in the same area is covered in acne around the mouth.

What perioral dermatitis is

"Perioral" means around the mouth. The American Academy of Dermatology (AAD) says the rash can also form around the eyes, the nose or the genitals, and that "Peri-orifical dermatitis is actually a more accurate name for this rash." Doctors also write it as periorificial dermatitis, which means a rash around the body's openings. When the rash sits only around the eyes, the AAD calls it periorbital dermatitis, and only around the nose, perinasal dermatitis.

A 2014 review calls perioral dermatitis "a common acneiform facial eruption found in both adults and children." Acneiform means it looks like acne. A 2026 review in the Journal of the American Academy of Dermatology describes it as a long-lasting facial rash of small bumps and pus spots, and says that "its etiology remains incompletely understood". Etiology means the cause.

Signs of perioral dermatitis

The AAD describes the rash this way: "This rash often looks like small, red, acne-like breakouts in people with light-colored skin and skin-colored breakouts in people who have skin of color."

Other signs the sources list:

• Itching or burning. "Whether red or skin colored, this rash can itch. Sometimes, the rash causes a burning sensation." Some people have neither.
• Dry, flaky skin. The AAD says: "You'll likely have dry and flaky skin where you have the rash, though."
• Where it sits. MedlinePlus, the US National Library of Medicine's health site, says the bumps appear low on the face, in the folds next to the nose and around the lips, and are worst in the lines that run from the nose to the corners of the mouth. It says a similar rash can also show up near the eyes, on the nose or on the forehead.
• Fluid or pus. MedlinePlus says some bumps may hold fluid or pus.

What triggers perioral dermatitis

No single cause is proven. The AAD says: "It's not entirely clear what causes this rash." These are the triggers the sources name.

Possible trigger	Source
A corticosteroid (steroid) medicine put on the skin for too long, including hydrocortisone cream	AAD, 2014 and 2021 reviews
A skin care product or toothpaste that irritates the skin	AAD
An allergy to something that touches the skin	AAD
Steroid nasal sprays, steroid inhalers and steroid pills	MedlinePlus
Face creams, makeup and sunscreen	MedlinePlus
Fluoride toothpaste	MedlinePlus
Not washing the face	MedlinePlus
Hormonal changes or birth control pills	MedlinePlus

Steroid creams have the strongest evidence. A 2021 systematic review, a study that gathers earlier research on one question, "found the strongest evidence to support topical corticosteroid misuse as the principal causative factor". Topical means put on the skin. The AAD says: "Many people develop this rash when they apply a corticosteroid medicine to their skin for too long." A 2014 review agrees that steroid cream on the face "commonly precedes" the rash.

How perioral dermatitis differs from acne

The two look alike, and MedlinePlus says people can confuse the rash with acne. These are the differences the sources give.

• Where it sits. The AAD's clue is "a breakout that looks like many small pimples, but it develops only around the mouth."
• Blackheads and whiteheads. A 2014 review of acne look-alikes says: "The major distinguishing factor in acneiform eruptions is that, in contrast to acne, there are no comedones (whiteheads or blackheads)."
• How the skin feels. Perioral dermatitis often comes with dry, flaky skin, burning or itching.
• What came before. A rash that started after long use of a steroid cream on the face points to perioral dermatitis.

Rosacea and contact dermatitis can look similar too. MedlinePlus describes perioral dermatitis as a skin disorder that looks like acne or rosacea. The AAD says rosacea breakouts "usually appear where you have redness on your face", and the NHS says rosacea causes redness across the nose, cheeks, forehead and chin that comes and goes. Contact dermatitis is a rash from something that touches the skin. The AAD's perioral page says an allergy to something touching the skin is one possible cause, so the two can overlap. A dermatologist can tell these conditions apart.

Why steroid creams matter

Hydrocortisone cream is a corticosteroid, and some forms are sold without a prescription. The AAD says: "To clear perioral dermatitis, you must stop applying all corticosteroids, including hydrocortisone cream, to your skin." MedlinePlus also says not to use any steroid cream bought without a prescription for this rash.

Stopping can be hard, because the rash can look worse first. The AAD says: "When you stop applying a corticosteroid or hydrocortisone cream, the rash can worsen." It adds that starting the cream again "will only bring temporary relief", and that each time you stop, the rash can flare. A 2014 review says steroid cream can make the rash look better for a while, "but there is a risk of rebound when treatment is stopped." Rebound means the rash comes back stronger.

If a doctor prescribed the steroid, do not stop it on your own. The AAD says: "Before you stop applying a prescription medicine, check with the doctor who prescribed it." The AAD adds that in some cases a dermatologist has a patient use a mild steroid cream for a while along with other medicine. MedlinePlus says a doctor may switch you to a weaker steroid cream and then reduce it slowly. That is a doctor's decision, made for one patient.

How a doctor treats perioral dermatitis

The AAD says the rash "may clear on its own", but some people need a dermatologist's help. It lists three parts of treatment:

1. Stop applying all corticosteroids, including hydrocortisone cream.
2. Take an antibiotic, which many patients receive. The AAD says some people need a different medicine.
3. Change the skin care routine. The AAD says you may need "to switch to a mild, fragrance-free cleanser", to wash your face gently, and to use fragrance-free skin care products.

MedlinePlus lists self-care steps to try while the rash is active: stop face creams, makeup and sunscreen, and clean the face with nothing but warm water. Once the rash has gone, it suggests asking your doctor for a mild cleanser. Ask the doctor who treats you which products to keep using.

The evidence for each medicine is limited. A 2022 systematic review of 11 studies with 733 people rated the certainty of the evidence for every treatment as low at best. A 2026 review says "no therapies are specifically approved by the US Food and Drug Administration for its treatment." That is why a dermatologist picks the medicine for each person. Azelaic acid is one option some doctors use, and azelaic acid for perioral dermatitis covers what the studies found.

How long it takes, and whether it comes back

Recovery is slow. The AAD says: "Expect gradual improvement. This rash tends to clear slowly. It may take a few weeks or a few months to clear completely." MedlinePlus says the rash needs several months of treatment, and that some treatments run for 6 to 12 weeks. Without treatment, the AAD says, "the dermatitis may last for months or years."

The bumps can return. MedlinePlus says most people who finish treatment do not get the rash again, and that it comes back more often in people who use skin creams containing steroids. To prevent it, MedlinePlus advises avoiding steroid creams on the face unless a doctor tells you to use them.

When to see a doctor

See a doctor or a dermatologist when:

• you have a rash of small bumps around the mouth, nose or eyes that does not clear,
• the rash started or got worse after using a steroid cream on the face,
• you use a prescription steroid on the face and want to stop it,
• the rash is near the eyes. Get help the same day if the eye itself hurts or your vision changes,
• sores blister, ooze or crust over, which can mean an infection such as impetigo or a cold sore.

The rosacea vs acne guide covers the other common rash in the middle of the face.