Perioral Dermatitis - Eczema, Meet Acne

By Sarah Villafranco, MD
Posted in Blog, on April 18, 2014

I have a lot of medical words in my brain, but few have been on my mind as consistently over the last several years as perioral dermatitis. Having suffered with it myself, I have done extensive research, both didactic and practical, often with myself as the guinea pig, and I am happy to share what I have learned.

What is it?

Perioral dermatitis (PD) is a very common condition of the facial skin (perioral = around the mouth), especially in women of menstruating age. It is frequently undiagnosed or misdiagnosed, and acts like a cross between acne and eczema. The fact that these two diseases behave very differently may, in part, explain why it is so poorly understood, and so troublesome to treat.  With continued research, and after talking to many people who suffer with the condition, I actually believe that PD is an endpoint that arises from a unique, fluctuating set of circumstances and predispositions in each patient.   As with a mathematical equation, different numerical combinations can add up to the same sum.  This is true of PD as well.  In some cases, it is clear cut, and directly linked to a particular cause.  But in most patients, the causes are multiple, uniquely combined,  and ever-changing  (making it even more difficult to treat!).

It varies in severity. In mild cases, it consists of patches of slightly bumpy, red or irritated looking skin, often with some mild flaking of the skin around the mouth, chin, and nose. (Some women experience symptoms near the outer corners of the eyes as well, though this is a less common location.) In more severe cases, the skin becomes very inflamed and angry looking in those areas, with flakes or scabs that can bleed or become infected.

Why does it happen?

There are many theories about the cause of perioral dermatitis, none of which are definitive. The most commonly proposed cause is the use of steroid facial creams, which are prescribed ubiquitously by western dermatologists. Other possible causes include fluoride toothpaste and sodium laureth sulfate. Exacerbating factors may include heavy creams or oils, cinnamon flavor/scent, and exposure to cold and sun.  I think we will probably learn in the future that there is a large hormonal component to the condition, as well.  It tends to resolve on its own as we age; it is fairly rare to see it over age 50, when our hormones simmer down and even out a bit.

My Story

I began having trouble with PD at age 36, a fairly typical age for women to have symptoms (generally age 20 to 45). My symptoms were also typical, and included redness, small bumps, and flaking of the skin around the chin, mouth, and nose.

When I first started studying natural skincare, especially with regard to this issue, 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 seemed to help consistently, and some (oils and heavy creams) made things worse. Hormone fluctuation definitely affected my symptoms, which were unfailingly worse in the days before my period.

I went to a local dermatologist after about 4 months. I told her I had perioral dermatitis. She agreed, and prescribed a topical antibiotic. As she wrote the prescription, I asked her if she had any experience with natural remedies, such as green tea extract, probiotics, and apple cider vinegar. She told me she was unfamiliar with homeopathy.  

I tried the antibiotic lotion for four days, and my symptoms got so much worse that I decided to be a bad patient and stop the medication. That’s when I got serious about figuring out a plan. Granted, this was not a randomized, controlled experiment. I made a bunch of changes at once, and could not tell you which one made the difference in my skin.

But here are the things I changed:


  • I stopped fluoride toothpaste (I switched to this one, which is also free of sodium laureth sulfate- Seafresh Toothpaste by Jason)
  • I stopped using sodium laureth sulfate in my hair care products.
  • I started evening primrose oil supplements (I like these - Barlean's Evening Primrose Oil. They also helped moderate my PMS symptoms, and who can complain about that?)
  • I took a less-is-more approach with my skin, which I continue to follow. I use this soap once or twice a day - Osmia Organics Black Clay Facial Soap - and I limit exfoliation in the perioral region (counter-intuitive, I know). After cleansing, I follow with this water-based serum -Osmia Organics Active Gel Toner. I leave the serum on for 30 seconds, and then follow with this cream - Osmia Organics Purely Simple Face Cream - applied sparingly around the mouth and chin.


While I make no claims about whether these steps will work for a person with PD, these minimally invasive changes have improved my symptoms dramatically. It took about 6 months (less invasive measures often require more patience), and I occasionally have symptoms around my cycle, when the dermatitis is visible up close in a mirror. Most of the time, people squint and stare when I tell them I have the condition, which tells me it is not usually noticeable. Wearing makeup (even a dab of powder, as I don’t wear any foundation) will make the dermatitis more visible, as well. 

With any of the lifestyle changes or products mentioned above, results may not be visible for 3-6 weeks - it is a condition that takes a long time to change, and requires patience and commitment on your part.  

How should I treat?

Dermatologists will treat this condition with topical or systemic (oral) antibiotics, over a course of 6-12 weeks. There is a moderate success rate with this course, as well as a relatively high relapse rate.   Avoid steroid creams at all cost, as they are suspected of having a causative relationship to PD. I have found, whether antibiotics are involved or not, that relapse is very likely without lifestyle modifications.

The first two changes I suggest are eliminating fluoride in toothpaste, and sodium laureth sulfate (SLS) in oral, facial, and hair care products. A healthy, plant-based diet, with appropriate supplements, such as evening primrose oil, and attention to beneficial fats and grain or legume-based proteins will make a positive change in almost any skin type. And, sufficient water intake (spring water is the best) will help maintain intracellular water levels in the skin, as well.

As for skin care, I choose my products because I love my products, and I know who made them and with what ingredients. But, the point is that you need to RESIST the urge to scrub your face and heap products on it. Perioral dermatitis wants to be left ALONE. It does not like heavy creams or oil-based serums. It wants water-based, simple products, and some peace and quiet.  

I can't promise you our products will work for you!  But, we have had a LOT of people say their symptoms have decreased substantially (if not dramatically).  Whether you purchase product from us or not, I am available by email for questions any time, and will do my best to respond to them within a week or so.  And, if you've purchased our products and want to touch base about how they're working for you, we are here to listen, and help you make adjustments if necessary.

Remember, above all – do less.  And, for your own sanity, keep track of the things you do, and try to think of them as pieces of a management strategy for PD, rather than looking for one "miracle cure".  It will likely be a condition that does not fully go away until it is good and ready, so it can feel more frustrating than it needs to if you are out to CURE it, rather than decrease the symptoms and render them manageable.  Make sense?

And, now that you've read the basics, maybe our blog post about PD Frequently Asked Questions will help with any other questions you may have - thanks for reading!


Related Products:


Hello, I am 23 and I have had PD on my face for 4 months now. With the hope that the natural almond cream, vitamin a oil, natural natural everything would work it didn’t. I am extremely healthy and i try to eat everything that is related to reducing inflammation in the body however that is not helping. I have recently stopped using all creams and have switched to gel (recommended to me by a RN).
Usuallly i notice i get PD in the winter however it started August 1! I am hoping it clears up soon.

Ashley on October 18, 2016

@ Lauren – I have not seen a correlation between electrolysis and PD, but it’s definitely possible that it’s irritating your skin, as well as the lidocaine! Can you take a little break while your skin heals a bit, and then try it again? As for supplements, the ones I have seen make the most difference are evening primrose and a B complex vitamin, but some people swear by zinc! (It makes me feel nauseated, so I don’t take it.) I hope your visit to the derm went well, and that he/she did not prescribe steroids. Sigh. Email us with any questions! Best – SV

@ Melanie – Sorry for the delayed response! I would not use essential oil OR coconut oil on PD – they will almost always exacerbate the condition. Make sure you’ve made the lifestyle changes recommended in this article and in our PD FAQ article, and email us with any questions! All my best – SV

@ Catherine – it sounds like you’re trying some good things, but the most important things you can do are these: avoid steroids, avoid fluoride, avoid sodium laurel/laureth sulfate in all products (toothpaste, shampoo, laundry detergent). We recommend our Black Clay Facial Soap to help PD-inflamed skin, as well as our Purely Simple Face Cream. You can add in the Active Gel Toner if your skin is happy after a few weeks with the soap and the cream. Please feel free to call or email us with any questions – my team is well-versed in PD management! All the best – SV

@ Janette – so lovely of you to share your journey, and I’m so glad our products have been a part of it. Makeup with bismuth often makes things worse for PD patients. Take a look at Alima Pure for a powder foundation for special occasions. I use IS Clinical sunscreen for the face, and it does not irritate my PD! Wishing you all the best – SV

@ Lisa – what a story! Sounds like you really went through tough times before you healed yourself – great job being patient, consistent, and educated! I am so glad our Black Clay Facial Soap and Purely Simple cream have helped your skin – nothing could make me happier than helping a fellow PD sufferer! All the best – SV

@ Marilyn – yikes! Garlic must have burned so much! It’s amazing the stories I have heard from people who have found remedies on the internet, so you’re not the only one trying anything and everything. But, remember that less is more when your skin is upset. Maybe a sample of our Black Clay Facial Soap and Purely Simple Face Cream would be worth trying. I might use raw honey rather than salt water in the meantime – salt water can irritate the skin when it’s already aggravated. Wishing you all the best – SV

@ Kimberly – I use the IS Clinical facial sunscreen (SPF 50) and it does not make my face mad. Maybe a little bit white, but they sell a light-brown tinted one if it works for your skin tone. Email us anytime with questions! -SV

Sarah Villafranco, MD on October 06, 2016

@ Kelsie – So sorry to hear of your struggle. Coconut oil often makes PD worse, unfortunately. And I can see how the Ponds could help the flakes but make the bumps worse. I’d recommend our Black Clay Facial Soap to start, with the Purely Simple Face Cream. Equally as important, get rid of SLS and fluoride in your toothpaste, and SLS in your hair care and laundry detergent. Those are huge – you probably won’t heal until you make sure you’re doing that. Also, anything you can clean up in your diet to support your skin? See our PD FAQ blog post for more ideas. All the best – SV

@ Ashley – Almost any oil applied to PD prone skin will make the PD flare up for most people. That’s why our Purely Simple Face Cream is mostly aloe juice, and has less oil than most moisturizers, The Black Clay Soap might help – samples are inexpensive, so maybe it’s worth a shot. And, as I said above, make sure you’ve made the lifestyle changes to support your skin (fluoride, SLS, and dietary modifications). Email us on the site with specific questions anytime. Best – SV

@ Cheryl – Great job educating yourself about PD, and switching up your toothpaste. I hope you’re seeing a bit of relief by now! (Sorry for the late response – our blog is going to notify me about comments soon – yahoo!) Please email us with any questions? Best – SV

@ Lisa W. – I feel your pain! I AM a doctor, and I can’t get my fellow MDs to stop prescribing steroids for a condition that is CAUSED by steroids!! Argh. I am so glad you were able to see some positive change in your skin, and I hope it has continued to heal. Email us on the site with questions. All the best – SV

@ Lisa – Elidel is not inherently “dangerous”. It, like steroids, is an immune modulator. That means that it decreases the immune response in your skin. Elidel targets T cells specifically, and is a little less of a “big gun” than traditional corticosteroid creams. That said, you can have a similar rebound reaction when coming off Elidel, though usually milder than a steroid withdrawal. In the end, both methods are band-aids, covering up a deeper issue. It makes more sense to try to address the root causes – stress, fluoride, SLS, steroid use, stress, stress, stress – than to treat only the symptoms. Check your makeup for bismuth – that ingredient makes my PD really mad! And look at our PD FAQ post for other suggestions. Best wishes – SV

@ C – All of our product are safe for use near the eyes. That said, periocular dermatitis can be very sensitive, and sometimes a few days of a very light layer of petroleum jelly can help it heal (not very “green” of me, but eyelid and periocular derm are a special case). Also, most periocular dermatitis is connected to constant irritation from shampoo or eye makeup. Make sure you are using completely unscented products, and stay away from SLS!! Email with questions – SV

Sarah Villafranco, MD on October 06, 2016

Hi Dr.
I just bought 2 of your soothing starter set samples and I’m so excited to try them for my PD. What do you recommend for sunscreen? All the chemical sunscreens cause breakout and make my eyes sting but the physical sunscreens leave my face white. Thanks!

Kimberly Adams on October 04, 2016

I suspect my PD started after I had a mild dermaroller treatment at a clinic, my skin was not cleaned before the treatment, alcohol toner used after, I am in my sixties and have used some very harsh products on my skin and never had any problems. So maybe finally now there is a breakdown. After using Nizerol (antifungal) for 5 weeks with little improvement Dr gave script for Clindamycin cream which I did not use as chemist recommended an antibacterial eye ointment, this did not appear to be much help. I crushed garlic with honey and applied, do NOT do this, I burnt my skin badly. so at the moment just dabbing with weak salt water . I appreciate all the comments on this site as it gives me an insight into the complexities of this condition. I was about to start on an antibiotic but after reading all this I do not think it is the answer. I have mature dehydrated skin so any suggestions would be much appreciated. I loved the Italian story.

Marilyn Smith on October 04, 2016

I am 39 and had been dealing with PD for 2 years. I had this awful itchy, red, bumpy rash around the left side of my face. I saw a dermatologist who prescribed Oxistat and ApexiCon cream to mix with water and use on the area. Within a week, it was clearing up. I used this cream for almost two years. Depending on how it looked is how many times a day I would apply. Usually it was 2 twice a day. It stopped working around January of this year. I have spent thousands of dollars, hours upon hours searching the internet for information, been to numerous doctors, such as a allergist, dermatologist, homeopathic chiropractor, etc trying to figure out why my face is breaking out in this awful looking rash. I was told there really is no cure for PD. The Oxistat and Apexicon stopped working so I quit the creams in June. Within 3 days my faced flared up so bad it was around my nose all the way down to my chin on both sides of my face. (every where I used the creams). I started using Apple Cider Vinegar with Mother Enzyme mixed with water for about a week and this seemed to help. Then starting using tea tree oil mixed with jojoba oil. I would put this on before bed and in the morning I would wake up with whiteheads that I could rub off with my fingers all around the inflamed area. This rash went through many stages of red bumps, white heads, flaky skin, scabbing. When I thought it was looking good, it would get worse. I changed my diet to no gluten, diary, or sugar. I started using toothpaste with no fluoride (Tom’s) and shampoo/conditioner that does not contain SLS. My face was so bad I didn’t even want to leave the house. After a month of trying all these different natural things, my face started to clear up a little, but was not enough to not want to hide. I stopped using everything and just washed my face in the morning and at night with the Osmia Organics Black Coal Soap and started taking 100mg a day of Doxycycline. Within the next couple of weeks my face was COMPLETELY clear! I took the Doxycycline for 29 days. I found out this awful thing I was going through was a with drawl to the creams. I think it originally started due to all the other products I used/tried on my face. I have always had sensitive skin and loved any new product that would make my skin look smoother and take away my wrinkles I don’t have. If you are having any issues I highly recommend using the Black Coal Soap and nothing else. If my face is dry I put on a little of the Purely Simply Face Cream. I believe this 2 year battle was self induced by a over load of product. I am eating everything I did before, but did cut back on gluten, diary and sugar. I am still using the SLS free shampoo and fluoride free Tom’s toothpaste. So far after 2 months my face still looks completely clear with no scaring. I pray it stays this way and wish the best for any one dealing with skin issues. It’s such a awful and embarrassing time. I highly recommend these products!

Lisa on September 23, 2016

I’m 51. I have issues with PD for over 20 years. In my twenties I was handed an endless supply of Elocon steroid cream from a dermatologist for eczema on my face and I used it liberally. I was on the birth control pill at the time. a few years later when I went off the birth control, my face exploded into acne like bumps that burned, but were flaky like eczema around my nose, mouth and chin. I saw another dermatologist immediately was diagnosed with PD and was prescribed varying dosages of doxycycline to clear it. It took 6 months, but it did clear. I would stay clear for 6 months or a year, and then have flare ups . Every time I would see a Dr. I would take the cycline drugs again, it was all they would offer. Finally, after having enough of the side effects being on antibiotics and knowing I was on them too frequently, I researched PD. I found that SLS was a problem and quit using Cetaphil (recommended by a Dr) and switched to SLS free shampoo and toothpaste. Tom’s of Maine Botanically Bright has no flouride or SLS, it works for me. I use ABBA Pure Moisture peppermint shampoo. I found Osmia and started using Oh So Soap which was a life changer. No more Dove soap (another soap commonly recommended by dermatologists). After reading about Sarah’s experiences on here and some email exchanges we had when I first purchased, I gave up wearing make up. to see what would happen? It was hard at first, but as I saw improvement, I got used to it. I also changed my diet, cut back on dairy, wheat and sugar. I had tried most of the natural remedies found online like AC vinegar, Calendula cream, Grapefruit Seed Extract, and Coconut oil. None of them worked for me, they all caused more irritation. Cinnamon based anything is also an irritant, Oh So Soap, Osmia Milk Bath and Purely Simple Face Cream are all products that I could used with my really sensitive skin. . I would love to find a foundation make up and a sunscreen that doesn’t cause a flare up, but I have yet to do so. Bare Minerals did not work for me. I have found that leaving the PD areas on my face alone, changing my products to the ones I have mentioned above have kept me clear. Many thanks to Sarah for sharing her experiences and creating wonderful products.. They gave me a guide to trying another strategy that worked for me and my face is clear. I am grateful.

Janette on September 21, 2016

Hello Dr Sarah,

Thank you so much for sharing and I am SO happy to have stumbled across this site. I am completely at the end of my tether with what I have been told is PD. I am 29 and after numerous back and fourth visits to the doctor and miss diagnoses, I decided to see a private dermatologist. I have been given oral anti bs which I am taking but have been told to only use 50/50 ointment on the area if needed. It is so sore, so itchy and most of all so embarrassing!

Is there anything you could recommend may help?

Thanks in advance

Catherine on September 02, 2016

Hello! I am so happy to have stumbled along this cite! I have had PD off and on for 2 years. For the past few months it has been really bad! Very painful and oh so embarrassing… My doctor put me on antibiotics and advised me to just leave it alone, however, it burns and itches and is extremely uncomfortable. Any advice on how to soothe the pain without making the PD angry? I am currently using lavender oil and coconut oil to relieve the pain, but I am hearing mixed things about using oil on it..?
Thank you!!

Melanie on August 23, 2016

Hi Sarah,

Thank you so much for this informative blog post and video! I recently self diagnosed myself with PD – seeing my dermo next week to confirm.

I have dealt with acne my entire life and after some research I read that zinc supplements can help with both acne and PD. My question is – is this safe? I definitely prefer to take a more natural approach to skincare. I have also looked into taking vitamin A and E supplements to improve skin. Any thoughts or recommendations would be much appreciated!

Another question I have is if you’ve ever seen a correlation with PD and electrolysis. I have been getting electrolysis for about 6 months, but recently started doing my upper lip. I use a numbing cream ( Numb Master 5% Topical Anesthetic Lidocaine Cream) and they recently starting putting bikini zone cream on my skin after instead of aloe vera. Do you think there is a correlation at all? I’d hate to give up electro – or the numbing cream!!

Thank you in advance for you help! Again, this information has been VERY informative and has given me some hope! :) I wish more doctors explored natural approaches before subscribing pills left and right.


Lauren on August 18, 2016

I have periocular dermatitis under the outside corners of my eyes only. Which of your products would be safe to use in the eye area as a means of treatment? Thanks for your time.

C on August 15, 2016

I am 56 and am having perioral dermatitis around my nose and on one side of chin. it is not bad compared to pics I’ve seen. Started when I used sunscreen and was out in the sun and heat. I use metrogel for it and elidel. I use metrogel 2xs a day and elidel as needed. When I use the elidel it is gone the next day. My dermatologist said to stop elidel after 6 wks and take a week off. I don’t use any SLS or fluoride before this started. I can’t figure out what is causing it, I have sensitive skin and used metrogel for years. I only use a gentle face wash and no moisturizer because I have oily skin. I use a mineral makeup with only 4 ingredients. Is this a fungus? Have not tried fungal cream. My Dermatologist said that 5% benzoyl peroxide gel and 1 % hydrocortisone will knock it out. Have not tried this too scared. Is it dangerous to use elidel?

Lisa on August 08, 2016

Thank goodness for sites like this—saved me from weeks or maybe months of rash agony given the stories I read from others. I had PD for 10 months, but not until last week did I know what it was or that the steroid cream I was prescribed and told over and over to keep using by three different primary care doctors, did I find that natural methods of healing were the answer. I threw away the antibiotic I was prescribed, because I am convinced that it was started this all for me months earlier. I was a series of recurring UTIs, and I had been on several antibiotics because I was being prescribed the wrong type for 3 of 4 infections. I am sure that is what damaged by system and manifested the rash. Here is what I did:
Apple Cider Vinegar with the mother (ACV) wiped on the area 2-3x/day—blotting only and treating the rash as though it could spread (not wiping and spreading)
Collodial Silver gel on rash 2x a day
Calendula cream very lightly at night; I did not start this until a few days of using the two above (not until it was less weepy)
I ingested ACV 1 Tablespoon each night; and gargled with it also
I began a very high probiotic, Flora brand, 42 billion

Those are the things I did, and in one week’s time it is 95% gone. Not noticeable to anyone but me—and a week ago it was extremely painful and unsightly. I was so worried, but am very grateful for the many people sharing what worked and what did not work. I tried Desitin one time; it seemed to soothe but I thought it was very difficult to remove and left a film that I thought would be more harmful than good. I once did honey on the rash, I don’t think it did anything really, but it did feel good.
I wish so much that conventional medicine would incorporate natural methods. I have no doubt that I would have been facing months of prolonged agony without finding these cures. I went cold turkey from the steroid (it was Clobetisol Propeonate that I was prescribed). Shame on my doctors for repeatedly telling me to keep using what was only making it worse over time.

Lisa W. on July 17, 2016

Hello eveyone, I’ve had PPD for years but tweaked it in different ways but eventually would come back. I just bought the Osmia Black Clay Soap so will see how this works in the next week or so. I have in the past had success with GLA & Biotin, then VitD3. I was using steriods then switched off to Tacrolimus from the Dermatologist but developed an allergy to it. Now my face exploded into a mess & had to go off it. Its @ my nose, chin, mouth, especially @ the eyes, eyelids. Its red inflamed & itchy. I did find SAGE made into tea form and applied to affected areas to be a way to manage this & find some comfort. I have been doing a gluten free diet/ Candida. I have many supportive supplements. Today I discovered, due to this site that my Tom’s flouride free TP has SLS in it. I was shocked bc I have been so careful of everything. Reading up on SLS confirmed how it destroys your natural skin barrier & causes many eye/skin issues like I have. Perhaps the next few days will be a hopeful beginning to recovery. I am a Massage Therapist & in the public eye alot so it has been distressing after always having great skin. Lastly, bringing attention to caring for the Liver & Kidneys is also something to look into. The symptoms on our bodies like eczema & psoriasis are linked to these organs being in disress :)

cheryl fishken on July 15, 2016

I’m 23 and have had PD for the last two years and also suffer from psoriasis and eczema. Psoriasis is also on my face so if I try one thing it’ll either work on only one half of the face or the other. I’m really tired of wasting money on skin care products that don’t work. I just tried argan oil yesterday and I had one of the worst PD break outs I’ve had since I was diagnosed with it. Has anyone had good results with the products here? It all looks great and I think I might get some samples just to try it out but I’m scared of damaging my skin even further.

Ashley C on July 11, 2016

Hello. I’m 18 and I’ve suffered with PD since the age of 15. I have the dry, flaky red skin around my nostrils and the sides of my nose and I get the pustules all around my mouth and lips. During the fall and winter my nose gets so dry that it cracks open and bleeds, and huge chunks of skin flake of sometimes…. not only is it unattractive but it’s extremely painful. Nothing I do helps. I’ve been to the dermatologist. they gave me a $200 cream that did nothing for me. I’ve tried treating myself with Lanolin and coconut oil but nothing really helps. I’ve found that if I use ponds cold cream facial cleanser I don’t flake as badly, and I use the ponds moisturizing cream as well. it’s very heavy but it provokes the pustules. another struggle I have is that if I don’t use the ponds moisturizer I will crack and bleed but if I do use it I get the pustules. I’m just starting college and I’m tired of this being a problem. I just want to feel pretty. do you have any advice at all?? it’d be much appreciated since my dermatologist visits over several years have been pretty much useless. thanks so much for your time.

Kelsie on July 10, 2016

@TC – Steroid withdrawal is a real problem with PD. People get frustrated (understandably) and keep going back to steroids to make their skin look better. But, it will never heal itself until you end the relationship with steroids entirely. I hope you were able to resist going back to them, and that your skin has started to heal! Be sure to get rid of fluoride toothpaste, sodium laureth sulfate in all toothpaste and shampoos, and work on managing stress. If you are patient and consistent, you should start to see change over the next few months. You might order a sample size of our Black Clay Facial Soap to see if it helps, as well. Sending love – SV

@Tina – I am SO sorry to hear of your struggle with PD. My heart truly goes out to you – I know the pain all too well, and it sounds like you had it worse than I ever have. It seems like you’ve found a plan that works to keep it at bay, most of the time. Coconut oil definitely makes it worse for me, so I’m glad it works for you! Did you ever try the Black Clay Facial Soap? I’m curious! And, yes, you are absolutely right that Italy can make almost anything better! That’s why I married an Italian!! Thanks for sharing your story – SV

Cassidy - Thanks for reaching out. Could you email us on the site to see if we can help you? I'm pretty sure we can make a few changes and decrease your skin's frustration. Just send to, and let’s try to make a plan. Sending lots of love! -SV

Sarah Villafranco, MD on July 07, 2016

I have this condition and I’m only 16 years old. I’ve had it since I was 12 or 13, and in general I’ve managed to keep it in check so that I was completely clear for months, then it would come back for a few weeks before disappearing again. However, in the last few months, I’ve found it impossible to clear up completely like I used to. It deals a huge blow on my self-esteem, and I’m worried that if I don’t get rid of it, it could negatively affect the rest of my life. I already find myself dreading having a boyfriend as I would never dream of kissing someone like this, yet if I cannot be intimate with someone, how will I find the right person to marry etc. Being so young, it’s hard for me to get hold of the recommended products for clearing up the symptoms, especially as my parents still believe it stems from dehydration, which I now know it does not. I’ve been using a regular lip balm to soothe it when I’m out of the house, and when at home I treat it with aloe vera gel and coconut oil, but in the last few days it has been a lot worse than it has been in a while. Please help, I have my school ball coming up in a month and I don’t want my pictures taken with an ugly rash covering my face!

Cassidy on July 06, 2016

I have had PD for the past 37 years (since my 20’s). I have literally tried everything in that time period. I have tried to relate it to my hormones, my eating, the products I am using.
It comes and goes for no apparent reason. When it comes it usually stays for months at a time. It gets really bad, covering the sides of my nostrils and mouth and sometimes my forehead with angry, red, scaly skin that is extremely painful,— to a mild rash looking area around just my nostrils. I have been to dermatologists, I have used steroids, I have tried eating healthy, I have tried eliminating things from my diet, I have done cleanses, I have eliminated flouride and regular soaps from my life, among many other things.
Steriods are not the answer for sure! They make it much much worse once you stop treatment. I learned that the hard way. My face broke out with the worst case of PD anyone had ever seen after using the sample tubes of steroids my dermatologist had given me over the course of a year, then being told my skin was addicted to the steroids and to stop applying them. The PD came back with a vengeance.
They only things I have found that just keeps it manageable and almost heals it are Primrose oils, Guaiacwood essential oil and Frankincense essential oil. Sometimes a super high quality coconut oil helps the itch and redness, but doesn’t make it better. I am a certified medicinal aromatherapist so I know the value and efficacy of the right essence (meaning the purest single ingredient) and have tried many, many different combinations on my own skin.
I do know that stress is also a major factor in PD. My PD had really been bad for the past several months, then I went to Italy for one month in May. I ate all the wrong things everyday, drank wine, used soap on my face, used flouride toothpaste, and by the end of the month my PD had completely cleared up for the first time in almost a year. So there it is, the cure for PD is Italy!
Even that is not definitive though, since I have had the most stressful three years of my life before that and no PD during that time.
I shall continue my quest for a complete cure.

Tina on June 28, 2016

I am 34 y.o. Male I have PD bad, around eyes nose chin temples. sounds like you got the right ideas. I was using a steroid cream kept it in check around eyes mostly. But it never went away I read not rouse the steroid so I stopped and started
Using calendula cream is so much worse just after two
Days what do you think the problem is the calendula cream or the stopping of the steroid. Please help I stop using those products thanks.

TC Ghisletta on June 27, 2016

@Ashley – hormones can play a huge role in PD symptoms, for sure. I find that taking evening primrose supplements (I use Barleans Organic EPO, two a day) and Oona Type 1 herbal supplements helps even the hormonal element substantially for me. You might try those and see if you notice a difference? And I would still recommend eliminating fluoride and SLS from all tooth and hair care products – it can only help! All the best – SV

Sarah Villafranco, MD on June 19, 2016

@Sarah – I have been dealing with this condition for I would say the last 3 years and have noticed the only time I get a “flare up” is literally the week before my period. So my question to you is… Would this be something that is caused by hormones ? And will the products you refer be something that would prevent these monthly breakouts From happening if it were hormone related. It’s really frustrating battling my own skin as it started just appearing one day for no reason at all. I will definetly try eliminating fluoride toothpaste and anything that you had mentioned. I think also that my brith control may have a big role in my outbreaks because i never had any type of bad acne as a teen or even a few years ago but once I started taking birth control it seems it’s never fully gone away so I’m thinking about going off of it for this reason and others so I am hoping this takes care of the reoccurring issue.

Ashley on June 17, 2016

Hey, just stumbled upon this and finally discovered what I have! I need help though, reading how to improve PD and getting frustrated because I’m already vegan, don’t use toothpaste with fluoride in or hair products with SLS and I’m still having trouble with PD on my chin and around my nose, what should I do? It did start when I started taking oral contraceptive and I think I may have other products with SLS in. I live in the UK too. Thanks in advance

Beth on May 28, 2016

@Caroline – Sorry for the delay getting back to you! I find that putting raw coconut oil on my face is very irritating to the PD, but that using it in the form of soap, a rinse-off product, mixed with the right blend of other oils, works very well. The Dead Sea Mud and hematite clay in the soap seem to have a really calming effect for the symptoms of PD in my case. As for mango, I think the same concept applies – I have actually had an allergic reaction to unwashed mango skin, but can use the soap with mango butter without any trouble. And I guess I would say to stay away from anything with the word laureth in it? Hope that helps! SV

@Nell – I think the steroid spray could be connected, as I’ve certainly seen PD in lots of people who use steroid asthma inhalers. It is not usually as simple as one thing, though. It’s likely a combination of factors, such as stress, sodium laureth sulfate in hair care and toothpaste and laundry detergent, and possibly the steroid spray. Try to resist the urge to treat it with a steroid cream, even if the derm recommends it, as that is one of the leading causes of PD. Email us on the site with any other questions! Best – SV

@Elizabeth – SO happy to hear that you have healed yourself by changing your diet! Amazing work by you, and such a tribute to the power we all have to heal ourselves, and the definitive connection between what we eat and our health. Thanks for sharing! -SV

@Nana – Be sure to eliminate all sodium laureth sulfate from her hair care, laundry detergent, and toothpaste. Great idea to work on how to administer her inhaler in a careful way. A clean, healthy diet is a great way to support her skin, and I would stay away from all steroid creams, as they are one of the main causes of perioral dermatitis (including hydrocortisone) – steroid creams on the face, especially in children, are often more harmful than helpful. She’s lucky to have a Nana like you to help get her on the right track!! Sending love – SV

@Ro – If you’re not doing all the “other stuff” to support your skin, like eliminating SLS and fluoride, you may not see lasting results from the antibiotics. Be sure you’re working on stress management, diet (anti-inflammatory), and getting rid of any irritants in your personal care and laundry products, and you’re way more likely to make meaningful change. All the best – SV

@Lyndel – Great suggestions – thanks for sharing your tricks, and for being your own teacher and advocate! Wishing you happy skin! -SV

Sarah Villafranco, MD on May 25, 2016

Perhaps not the cure, but I find the best way to manage my own peri oral dermatitis is definitely through eliminating SLS , not only in personal products (toothpaste, moisturizer, cleanser, shampoo, conditioner, soup, deodorant, makeup etc) but also in household cleaning products (or at least wear good gloves). Diet is another element that helps . I’d recommend a paleo or plant based diet with minimal sugar, fake flavoring, spices, fruit (fresh fruit and dried fruit) and processed foods. I find fruit and tomato effect my skin the most. (A friend of mine found coconut was the cause of hers) My skin clears up within a couple of days if I follow the above. Hope this little bit of advice helps at least someone as we all know how debilitating this skin problem can be. Ps I’d also like to add that I did one cycle of doxycycline only to have my peri oral come back within a year. The cream my GP gave me. Just worsened the condition.

Lyndel on May 24, 2016

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