I Thought I Just Had Dry Skin, But It Was Actually Perioral Dermatitis

When I think back to last March, when safer-at-home restrictions were first placed here in Los Angeles, it's pretty wild I that thought we would be indoors for just a few weeks and that my hair and skin would flourish. Two months later, I was wrong on both fronts. Of course, there are many more important things to be concerned about during the COVID-19 pandemic than the state of my skin, but back then, I thought skipping makeup and letting my skin rest from treatments was going to be a nice break — at least for my face. I didn't take into account the way stress can wreak havoc on skin and that these aren't normal times. 

In my case, that meant a flare-up of perioral dermatitis (PD), a scaly red rash, to the right of my mouth. It's something I had never even heard of and definitely was not the run-of-the-mill dry skin I assumed it to be. But what is PD, exactly? Well, it's sort of like rosacea. "Perioral dermatitis is a condition where patients develop red, bumpy, or sometimes pus-filled bumps around the mouth, nose, and chin," Joshua Zeichner, a board-certified dermatologist in New York City, tells me. "In some cases, it can also develop along the outer part of the eyelids and cheeks."

It turns out that the facial rash is somewhat common both around the mouth and under the nose. After I posted about it on my Instagram Stories, multiple people messaged me to say that they, too, have experienced the skin condition. Unfortunately for me, each of them had pretty different advice for me. Some told me to exfoliate with alpha hydroxy acids (AHAs), others said to use only the most gentle skin-care products. Many said a topical antibiotic cream was all that would work. For something so common, why is there so much confusion?

"Despite being common, we still do not understand why perioral dermatitis develops," Zeichner explains. According to him, there are many theories, including the use of topical cortisone creams, fluorinated toothpaste, heavy skin-care products, asthma inhalers, and — yep — stress. "Especially during quarantine, stress levels are at an all-time high," he says.

My attempt at covering up PD with makeup.

My red pumps aren't fluid-filled, but I did have a small rash under my nose before it popped up by my mouth. Sometimes the area even burns and feels tight and uncomfortable. According to Morgan Rabach, a board-certified dermatologist in New York City, this is also common. "The rash may be accompanied by itching or burning, or it may just appear with no sensation at all," Rabach tells me. "[It often] appears really for no reason around the mouth, nose, or eyes and comes and goes." 

Dermatologists agree that we don't really know why it happens, but we can treat it and hopefully prevent it from coming back. "Any environmental change can lead to perioral dermatitis," says Rabach. "Using different skin-care products, for example, with new ingredients that may cause inflammation in your skin." She notes these ingredients can include fragrance, dyes, or preservatives, especially if you're allergic, as well as actives such as retinol and acids.

Zeichner says he's seen patients try out all kinds of new skin care while self-isolating. I am not one of those people, though; I've been sticking to my normal skin-care routine. Sure, everything else in my routine has changed: I'm indoors way more often and I'm not sleeping as well. Still, it seems to have come from nowhere.

Kate Somerville, aesthetician and founder of Kate Somerville Skin Care, says she sees this a lot in her Los Angeles clinic. "Very often, we see clients with perioral dermatitis," she says. "We see this with a variety of clients with different skin tones and ages." She treats the condition with a soothing facial to decrease inflammation and redness, as well as LED light therapy. But Somerville agrees that it's really about prevention and decreasing flare-ups. She recommends skipping exfoliation when PD starts, using tepid water while cleansing the skin with a gentle cleanser (Allure editors love StriVectin Comforting Cream Cleanser), and avoiding product regimens that contain fragrance and dyes.

Renée Rouleau, aesthetician and founder of Renée Rouleau Skin Care, gives me similar advice. Rouleau has only seen skin-care changes and prescription medication help diminish perioral dermatitis. "I have not found any other lifestyle changes work for PD," she says. "It's basically to remove any potential topical irritants, such as products with active ingredients." She recommends "really basic" products, such as a gentle, sulfate-free cleanser and a simple moisturizer (Allure editors also love Dr. Jart+ Cicapair Tiger Grass Calming Gel Cream).

Dermatologists agree. "You need a prescription when the rash isn't going away and keeps coming back and you don't know why," says Rabach. She likes to do an allergy patch test in her office to see if she can isolate what could be causing it.

All this considered, less is absolutely more when it comes to PD. I put down all my acids and vitamin C serums and retinoids and switched to a gentle, fragrance-free routine. The rash around my mouth calmed down in terms of being dry and itchy, but it was still there. I needed a bit more intervention with a prescription, it seemed.

If changing up your skin-care routine and avoiding irritations and allergens don't work (like in my case), a topical antibiotic might do the trick. Zeichner likes prescriptions such as Metrogel and Soolantra if over-the-counter treatments don't take care of the problem in two to four weeks. Oral antibiotics are also sometimes given for their anti-inflammatory properties, says Rabach. These medications work at decreasing redness and swelling and are used for rosacea as well.

In the meantime, I started checking the ingredients in my skin care more. I've noticed products with fragrance, especially products that aren't rinsed off, such as night creams, make my PD worse. I'm also trying to take better care of myself in general, especially considering Los Angeles has extended stay-at-home orders. That means eating real meals (popcorn doesn't count), getting some physically distanced fresh air, and going to bed earlier.

We don't always realize how stress affects our body until there's an issue that needs to be fixed. I ended up getting a Metrogel prescription and watched my skin start to heal within a week. Hopefully, with a little care and some medical intervention, my skin might even flourish after all.

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