Perioral dermatitis (PD) is a common skin condition that affects the face — perioral means “around the mouth." Though it can vary in severity, it's never fun. Mild cases result in patches of slightly bumpy, red or irritated-looking skin, often with some mild flaking, like an angry skin goatee. With more severe cases, skin becomes very inflamed, with flakes or scabs that can bleed and become infected.
In short, it's pretty awful.
I should know: I began having trouble with PD at age 36. My symptoms were typical: redness, small bumps, flaking of the skin around the chin, mouth, and nose. It was a stressful time in my life (career change), and I was monkeying around with hormonal birth control, so my body chemistry was in flux.
I experimented a LOT on my own face. From yogurt masks to apple cider vinegar to nourishing oils to heavy creams, I explored options. None of the “cures” I tried seemed to help consistently, and most made things worse (especially oils and vinegar). My symptoms were unfailingly worse in the days before my period.
A dermatologist prescribed a topical antibiotic cream, but my symptoms got so much worse that I decided on my own to stop using it after only four days. That’s when I got serious about figuring out a plan that would heal my skin for the long term, rather than temporarily diminishing the symptoms, only to have them come galloping back once I stopped treatment. I needed to start at the beginning, which meant getting to the bottom of why it was happening.
Since PD acts like a acne had a baby with eczema, it's frequently misdiagnosed, poorly understood and troublesome to treat. The truth is, PD is a symptom that arises from a fluctuating set of circumstances unique to each patient, just as fever can be a symptom of countless different diseases. In some cases, the cause of PD is fairly clear: stress or pregnancy or steroid creams. But in most patients, the symptoms are caused by a combination of factors that push the skin into a state of distress.
Here are the most common causes of PD:
- Steroid creams on the face (prescribed ubiquitously by western dermatologists)
- Steroid inhalers in children
- Fluoride toothpaste
- Sodium laureth/lauryl sulfate (foaming agent) in toothpaste and hair care products
- Stress (this is a big one, from causation to long-term management)
- Immune function (people with overactive or underactive immunity may develop PD)
- Diet (food intolerances may manifest as skin issues)
Once you have PD, here’s what will make it worse (in my experience):
- Heavy creams and oils
- Topical antibiotics (in some cases)
- Excessive coffee drinking
- Cinnamon flavoring
- Monthly hormone fluctuations or pregnancy
- Inflammatory diet (high in refined sugar, meat, and gluten)
So how should you treat your PD? While there's no one-size-fits-all cure, I'd suggest two initial changes. The first is to eliminate fluoride in toothpaste, due to the substance's ability to cause and aggravate inflammation. The second is to stop using oral, facial and hair care products that contain SLS, as it's a known skin irritant.
A healthy, plant-based diet and attention to beneficial fats, grains and legume-based proteins will also make a positive change in almost any skin type. Sufficient water intake will help maintain intracellular water levels in the skin. And managing your stress — both in general and regarding your skin — is critical.
As for skin care, the main takeaway should be that you need to resist the urge to scrub your face and heap products onto your skin. PD wants to be left alone; it doesn't like heavy creams or oil-based serums. It wants water-based, simple products, and peace and quiet. So remember: do less.
For your own sanity, keep track of what you're trying, and think of them as pieces of a management strategy for PD rather than looking for a miracle cure. It'll likely be a condition that does not fully go away until it is good and ready, so it’s more frustrating than it needs to be if you are out to CURE it, rather than decrease the symptoms and render them manageable.
And a last tip from someone who’s been there: if you’re hunched over your computer in the wee hours of the night, compulsively searching for "cures," you need to stop, take a breath, and do a perspective check. You have people who love you, access to fresh water (and the internet), and you are beautiful in a much-more-than-skin-deep way.
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