Alongside the COVID-19 pandemic, we are seeing a pandemic of related skin issues. Aside from hand dermatitis, we are seeing flare-ups of chronic conditions such as psoriasis and eczema. And Perioral Dermatitis. These conditions are all exaggerated by STRESS!
Perioral dermatitis (POD) I see most commonly in young women, and believe it or not kids. Yep POD in kids is common!
Perioral dermatitis is tiny red bumps around the mouth, nose and sometimes eyes. It responds well to cortisone creams like 1% dermaid and hydrozole.
However these actually in the end feed the rash and it rears up stronger when they are ceased.
In women, it is often the result of using too many active ingredients in skin care on the skin. Fluoride in toothpaste has also been implicated. In kids, the use of steroid inhalers for asthma can contribute.
The stress of this pandemic means I am seeing many more cases of this annoying rash!
TREATMENT for PERIORAL DERMATITIS?
- STOP all actives on the skin.
- Stick to LIGHT moisturizers and gentle cleansers.
- STOP all steroids creams ( and inhalers if safe to do so)
- Trial a non cortisone anti-inflammatory cream such as tacrolimus.
- Most cases need (and respond well to) oral antibiotics for a period of 6 weeks - based on weight in kids. These must be prescribed by a doctor.
- LED light may also help perioral dermatitis settle more quickly and take the redness out.
The good news is most cases of POD settle completely with no need for further treatments. Some redness may persist for a while and if bothersome can be treated with a vascular laser.
What is periorbital dermatitis?
The word periorbital is defined as meaning "around the eye." The root word, "orbital" deals with anything having to do with the eye, while "peri" means around or surrounding. If you have a red rash around your mouth or eye, you might have a type of dermatitis called perioral (oral meaning mouth) or periorbital dermatitis.
Your skin might be scaly and flaky with inflamed bumps that can itch and burn.
Periorbital dermatitis is common and doesn't always respond well to treatment. Because the face is so visible, many people with this condition are very distressed as it is not easily hidden and the things (such as makeup) that could hide it, will likely make Periorbital dermatitis worse.
The disorder is usually persistent, and patients often have to try different topical treatments before they find what helps them.
Periocular dermatitis can have many different causes, including allergy or irritant allergic due to an irritant making contact with the skin, and further skin disorders. However, the exact cause of periorbital dermatitis is often difficult to determine and doesn’t always have a known cause.
If you think you may have periocular dermatitis, it is important to see a doctor or dermatologist for diagnosis and treatment.
Perioral dermatitis treatment in Australia
In Australia, Perioral dermatitis is usually diagnosed with a visual examination by your dermatologist or General Practitioner. A trusted healthcare provider can also do a biopsy of the skin, though this is not always needed. This is usually only done if there is another potential cause that needs to be eliminated.
The main treatment is to stop using all active treatments and skincare products that may be exacerbating the symptoms, and only use light moisturizers and gentle cleansers to replace them.
If it is safe to do so, also stop using all steroid creams and steroid inhalers (make sure to run this by your main healthcare providers first as not everyone can stop these safely without a plan in place).
Another step for treatment can be trying a non-cortisone anti-inflammatory cream, such as tacrolimus. In most cases, oral or topical antibiotics for a period of 6 weeks will help the perioral dermatitis settle more quickly.
These must be prescribed by a doctor and only particular antibiotics will be helpful so your doctor will advise you on which treatment is best.
LED light therapy may also help reduce the redness, swelling and pain, this is done at skin clinics so contact a dermatologist to discuss this as an option.
What triggers perioral dermatitis?
The most common cause of perioral dermatitis is an allergic reaction or sensitivity to certain ingredients. These ingredients may be found in your day to day products such as your makeup, cosmetics, washing detergent or contact lenses.
Hypersensitivity to nickel sulphate is another trigger for a lot of people (which can sometimes be found in the products listed above).
Hormone fluctuations can contribute, occasionally to young women on the contraceptive pill experiencing skin changes.
Topical steroids (such as hydrocortisone creams) are usually thought to be the cause. These creams usually help to get rid of symptoms of perioral dermatitis very quickly but as soon as they are stopped, it comes back with a vengeance.
Stress is another trigger that is often overlooked and should be taken seriously.
How do you get rid of perioral dermatitis naturally?
If periorbital dermatitis is determined to be caused by an allergy to a particular substance, the best course of action is to avoid contact with that substance.
If the cause isn’t known then stop any products, especially those that are new. Cutting out any steroid products, face creams, moisturiser, sunscreens, fluoridated toothpaste and some natural skin products like essential oils, dye or even perfume. All of these contain many ingredients that can cause irritation and redness.
If you are looking to avoid using medications or medicated topical treatments and want to try natural products, then replace all current products with a gentle moisturiser and soap, you can purchase one from your local pharmacy (though make sure it is sensitive and fragrance free).
Many companies claim that natural ingredients, such as aloe vera and coconut oil, help soothe and reduce redness however these are not recommended by dermatologists to treat perioral dermatitis due to the lack of supporting evidence.
If you want to try these then make sure if you have any flare up of symptoms, that you stop using the product immediately.
You can try to reduce stress in your life through exercise or meditation. Stress has many effects on the body, not all of them fully understood. Reducing stress, therefore, has many benefits and could help to ensure treatments work more effectively.
Keep a daily journal if the perioral dermatitis is persistent to help determine possible causes. You can go back to it and see if any flare up days have anything in common.
How do I get rid of perioral dermatitis on my face?
The thing about perioral dermatitis is that it might get worse before it gets better. There are a few different medications that can help, but it might take weeks or even months for them to start working. Book an appointment to see a dermatologist or a General practitioner.
You can discuss a plan. This involves stopping all skin products, coming up with a gentler skin care routine, Oral or topical antibiotics and stress reduction.
Signs perioral dermatitis is healing
When perioral dermatitis is healing it can often take weeks or months until it disappears completely. Sometimes the red bumps will go away, reappear somewhere else or come and go. Don’t worry too much, this is common throughout the healing process.
Eventually, it will come back and then fade for good. Sometimes it can reoccur once treated (the good news is that usually, the treatments that worked before will probably work again).
Perioral dermatitis and diet
Diet and Perioral dermatitis has not been studied in depth at this point. For atopic dermatitis like eczema diet is a pinnacle part of treatment for many people. This doesn’t mean that it isn’t beneficial for Perioral dermatitis, just that there are no ‘magic foods’ to treat it.
There is thought to be a slight correlation with perioral dermatitis and gluten or other food intolerances.
Eating well has known benefits for skin and every aspect of our health. By that logic, trying your best to keep to a healthy diet and reducing consumption of processed foods, alcohols, dairy and meats, you will have improved overall health and may find it helps with perioral dermatitis.
The best way to prevent it? BREATH, RELAX and avoid stress (haha easy she says).