The Sneaky Mouth Rash Troubling Dermatologists & Hailey Bieber

Photographed by Rochelle Brock.
A few weeks ago, I noticed the first sign of an itchy chin rash. It looked a lot like acne at first: white, pimple-looking bumps on the left corner of my mouth. But I now know it to be perioral or periorificial dermatitis (PD), a form of rosacea localized to the mouth, eyes, and sometimes around the nose.
The condition was new to me, but I learned it's fairly common. Hailey Bieber has it, too. Despite having really-good skin most of the time, Bieber self-describes her skin type as "so, so sensitive" and trying new products that are too harsh triggers her PD. I've heard similar stories recently. Skin-care writer Tanya Akim has talked about her PD flares, and beauty reporter Kirbie Johnson spoke on hers in a recent episode of Gloss Angeles.
Dermatologists confirm that perioral dermatitis is common: "We deal with perioral dermatitis all the time in our practice," says New York-based dermatologist Hamza D. Bhatti, DO, FAAD. He has seen an increase in cases since the onset of the pandemic, with mask use. According to Dr Bhatti, the patients experiencing PD are women, by and large. "Men have developed it, but I see it a lot more often in young to middle-age women, from 18 to 40s," he adds. "We're trying to figure out why it's happening."
On the on Gloss Angeles podcast, cosmetic chemist Krupa Koestline offered that PD cases (both the rise and the demographic) could be linked to our collective overuse of skin-care products. "Everybody is trying to use all of these new actives, like retinols or BHAs," which are exfoliating acids, Koestline explains. "Over the years, this has caused skin barriers to be disrupted. Because of this, there's a lot more of an occurrence of perioral dermatitis than there was a few years ago."

What is perioral dermatitis?

For deeper context, perioral dermatitis is a form of rosacea that can be easily confused with acne. I made the mistake of trying to pop my pimple-presenting chin rash, but that caused a spread so I stopped and called my derm. "Often with perioral you get a few pustules," explains Dr Bhatti, "which are like these white-topped, pus-filled areas that usually hang out around your mouth."
If you see a small rash around your eyes, too, it will look different. "It's mostly around the lateral or lower eyelid," adds Dr Bhatti. This looks less like acne and more like dryness, rosacea, or an eczema reaction — but you want to be very careful not to treat perioral dermatitis like eczema.
@teawithmd Another #trythisnixthat : #perioraldermatitis edition! Treatments involve both identifying triggers and avoiding them AND seeing a #dermatologist for proper medications #dermbypark #rash #acne #rosacea #skincare #skincareroutine #skincaretips ♬ original sound - Dr. Joyce Dermatologist

What causes perioral dermatitis?

Periorial dermatitis is especially tricky because, as Dr Bhatti tells me, there's no way to determine what the exact cause is. He says the most well-documented triggers of perioral dermatitis are steroids (like Hydrocortisone cream) and some toothpastes.
Dermatologist Geeta Yadav, MD theorizes that perioral dermatitis is related to your skin's microbiome, the collection of normal bacteria which lives on your skin. "For whatever reason, you have [irritants] playing with the acne bacteria and causing an inflammatory release of [substances called] cytokines." Dr Yadav says that part of what causes rosacea. "We also know that steroids can induce more sebum production and that's maybe why perioral flares with steroid use," explains Dr Yadav.
As with inflammatory skin conditions like acne or eczema, other factors include stress, hormones, environmental factors or a compromised skin barrier from overusing harsh ingredients.

How do you treat perioral dermatitis?

Do not fall down a Reddit hole. If you think you might have perioral dermatitis, you'll want to see your dermatologist because self-treating can make your problem worse. "A lot of people confuse [perioral dermatitis] with eczema," says Dr Bhatti. "In that case, you might think to treat it with a little bit of a topical steroid [like OTC Hydrocortisone], but that will make it worse." If used incorrectly, steroids may make the rash better, but it could flare up again later.
Instead, your dermatologist will likely prescribe a dose of Doxycycline, an oral antibiotic with anti-inflammatory properties, as well as a skin-care elimination for a few weeks. "The first thing I would do is an elimination," says Dr Bhatti. "Use a regular hydrating cleanser, something like a Cetaphil, which is very mild. Clean your face, but stop everything else."

How do you prevent perioral dermatitis?

By eliminating everything in my skin-care routine, my perioral dermatitis cleared in a few weeks. To prevent it from coming back, I'm very mindful about reintroducing certain ingredients. The general dermatological guidance is: less is more. "It's all about gentle, non-occlusive products," explains Dr Yadav. "Don't slug. Use oil-free makeup. Stay away from anything harsh, like a retinoid or heavy acids or things that are really occlusive or fragranced." 
Dr Bhatti agrees: "When you're reintroducing things back to your face, you want to make sure you're doing to least amount of damage possible. "Using a good cleanser and a great sunscreen is really all you need." Dr Bhatti recommends EltaMD mineral sunscreen. If you're dry and in need of a moisturizer, he recommends something with niacinamide, for its anti-inflammatory properties, as well as glycerin, or hyaluronic acid. Rhode Barrier Repair Cream is a good pick (obviously, the skin-care Bieber uses), as is the Neutrogena Hydro Boost, which Dr Bhatti recommends.
After experiencing perioral dermatitis, am I on a lean skin-care regimen: gentle cleanser, moisturizer and sunscreen — but it's not forever. "Slowly, you can start experimenting with things," says Dr Bhatti. "It's all about awareness of what is going on your face."
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