Perioral Dermatitis - The FAQs

By Sarah Villafranco, MD
Posted in Blog, on August 21, 2013

Since writing my first article about perioral dermatitis, I have become a bit of an accidental expert on the subject. We get a huge number of emails each week from people who are interested in a natural and more gradual approach after steroids and antibiotics have left them frustrated and feeling hopeless. I’ve had the amazing privilege of seeing some before and after photos, in which the condition is hardly noticeable four weeks after putting our plan into action. I’ve also been incredibly touched by reports of people going out on dates for the first time in months, women wearing way less makeup because their skin looked so much better, and people just generally remembering how to smile again!

There are a few questions that seem to pop up repeatedly in the PD population, so I thought I would address some of them here on our blog. If you're looking for a quick reference to which Osmia products we recommend for PD, see the bottom of this article. And, if you haven’t read the original article about PD on our site, you should start there – these are follow-up questions after covering the basics. 



You need to look for a toothpaste that is free of BOTH fluoride and sodium laureth sulfate. The product I mention in the article is called Jason Seafresh Deep Sea Spearmint, and it is the paste, not the gel. I get a lot of calls from people who are using fluoride-free toothpaste, but are surprised to find that SLS is still hiding in the ingredient list – you have to double check this (even Tom's has SLS in some flavors!). Avoid cinnamon flavoring, in toothpaste and elsewhere, as it can irritate PD symptoms.


Ugh. This is the toughest question I get about PD, and one that may have a different answer for different people. While my goal is to use the most natural products I can, the only two natural options when it comes to sunscreen are zinc oxide and titanium dioxide. These are referred to as barrier sunscreens. They are not absorbed by the skin (unless nano-particles are used), and work by reflecting the ultraviolet rays. They are effective immediately on application, and are considered less toxic than chemical sunscreens. (Nano-particles of zinc and titanium are much smaller, and are potentially absorbed by the skin. They also have some negative environmental impact, so they are less in favor with the green crowd.)

Here’s the problem: many of the natural sunscreens I have tried make my PD symptoms worse. Many of them are oil-based (likely in an effort to help spread the thick, white minerals), and the heavy oils make my red bumps appear. Non-nano zinc and titanium are very white, and can make flaky skin look more pronounced – no good. So, I end up alternating between a mixed mineral and chemical sunscreen made by Elta MD (SPF 46) and a mineral one by iS Clinical called Eclipse (SPF 50). They're not perfectly green, which is not ideal, but they're not as full of awful ingredients as many mainstream sunscreens, and they have no fragrance or parabens. I put on sunscreen when I am headed out for a run or a ride, and when I will be outdoors for any length of time, and I wash it off as soon as I am done. That said, chemical sunscreens do get absorbed by the skin, and they don’t “wash off” fully the way barrier sunscreens do. So, I am choosing a somewhat higher level of toxicity for a product that does not make my face as angry. I try to use the mineral sunscreens on the rest of my body, which is a much larger surface area and does not mind the heavier texture.

My advice? Experiment with some natural sunscreens like Coola or Suntegrity – look for ones that don’t use lots of oils/butters, and see if you can find one that works for you. If not, you may need to choose a chemical screen for just your face until you find a natural one doesn’t exacerbate your PD. I’ll let you know if I find one, or if I develop one myself!


Most importantly, choose a brand that does not use sulfates. There are lots of them out there now, and some work better than others. Now, I have more hair than most people (long, thick, coarse - a family of chipmunks could live there and I might not know it), so keep that in mind.  Here are the brands I come back to again and again:

  • Desert Essence (unscented) is inexpensive, and great for people with chemical and scent sensitivities.  Also nice to use on your kids, as you don't cringe when they spill 1/4 of the bottle from squeezing too hard. 
  • Josh Rosebrook shampoo and conditioner take a little getting used to if you like the feeling of a sudsy wash, but it's worth the transition. The scent is divine, and the products are very moisturizing, which I love as a Colorado girl. He just released a lighter version of shampoo and conditioner as well, which might work better for someone with thin or very fine hair.
  • GM Reverie Nude Shampoo & Conditioner is a relative newbie on the green beauty scene, released last June. For those who like a little foaming action, but still need a very nourishing conditioner, this is a great pick.
  • Clinical Luxury Hair Smoothie was a gift to me from Graydon at A Night For Green Beauty this year, and I love this stuff as much as I love all my other green smoothies! It leaves my hair incredibly soft, and smells like sage and thyme and all things wonderfully herbal and healing.
  • As a side note, I tried the very expensive Rahua, which has lovely ingredients and uses Palo Santo essential oil – an oddball scent that I actually adore. But it left my hair a bit heavy and dull, and if it can do that to my big, wild head of hair, I would think that effect could be more pronounced in someone with thinner or finer hair.  I may need to give it another try, as it's so well loved in the green beauty world!


Ideally, you should not use any makeup while your skin is angry and red. Almost all foundation and pressed powder will irritate it further. But, if you have an important occasion and need to use something, certain brands may upset things less.  

  • W3LL People is an incredible brand, founded by incredible people. I have tried a few of their products and just love them.  Specifically, their Bio-Brightening Powder and Bio Extreme Lip Gloss are incredible, and I've heard amazing things about their mascara!
  • Alima Pure is wonderful for eyeshadows and blush, with a huge array of colors.
  • Kjaer-Weiss, Vapour Organic Beauty, and RMS Beauty all have huge fan clubs, as well. I have a castor oil sensitivity, so I can't use some of their products, but that's just me!
Ingredients to avoid in makeup over the affected skin are bismuth (in many mineral foundations and powders), talc, parabens, petroleum, and possibly beeswax (it forms a heavy layer on the skin and can be too occlusive).


Ouch. I know it’s painful even to discuss. I generally recommend limiting coffee to a cup or two a week, and drinking tea the other days if possible. I don’t think it is the caffeine that revs up PD symptoms, so drinking decaf doesn’t really help, and black tea seems fine for my skin. I think it is something specific to the coffee bean itself. This is seriously unofficial.  And coffee has been shown to decrease the risk of Alzheimer's Disease, so you need to prioritize...


Again, this may vary significantly among PD sufferers. In traditional Chinese medicine, the area of skin affected by PD is linked directly to digestive issues. I have yet to perform the studies, but I would wager that the incidence of Irritable Bowel Syndrome and gluten intolerance among the PD population is substantially higher than the general population. I have had some digestive issues myself, despite an absurdly healthy, vegetarian diet over the last 15 years (tummy aches, indigestion, gas, and similar unpleasantness). After a suggestion by a friend from med school who is now one of the best internists I know, I have been following a fairly obscure diet called the low-FODMAP diet. Even for me, it is just about impossible to explain. Google it. But as I looked at the list of foods to limit, I kept thinking “Oh, yes – that gives me a stomach ache, and that gives me indigestion,” and so on. So I gave it a shot. It’s not easy, especially being a vegetarian as well. But it does make my digestive issues substantially better.

In general, I have found that the three most inflammatory food groups are wheat (gluten), dairy, and sugar. Not a shock to most of you, I’m sure. So, I recommend that PD sufferers limit these items significantly. It’s just not as hard as you think it’s going to be – I promise. Tons of dark greens, fresh veggies and fruits, less processed food in general. If you can’t figure out what to eat, pretend you’re Japanese. Rice, vegetables, some tofu, maybe some fish.  And, of course, subscribe to our newsletter for great recipe ideas. 

All this said, do not become a complete stress case over your diet. Stress is ABSOLUTELY a factor in PD symptoms, and if you are in a state of perma-spaz over what to eat, you will not be helping yourself.


Calm yourself. Breathe. Take a step back and get a bit of perspective. Having PD is not fun. It’s your face, and it affects your confidence and your interaction with the world. But it’s not cancer. It’s not hunger, or lack of fresh water, or poverty. And it doesn’t define you.

The simple fact is that the more you stress about the condition, the worse it gets. I think there may be a correlation between PD and Type A personalities as well! This is not meant in a derogatory way – I am Type A Plus, if there is such a thing. It just means that the same adrenaline that can make Type A people super-productive can also have an effect on the skin. So, be less Type A about your face! Stop spending endless hours hunkered in front of your computer researching miracle cures (because there are none). Don't look in the mirror every five minutes. Stop trying olive oil & powdered sugar one day, and yogurt masks the next, and vinegar the next. Your skin won’t calm down if you don’t calm down and stop changing the routine every couple of days!

Instead, set your intention to reduce your symptoms with patience and kindness. Remember who YOU are on the inside, which is clearly what matters to this world vastly more than the appearance of your chin. Manage your stress about this condition and anything else that feels out of control with breathing, yoga, meditation, exercise, or a cup of tea. Approach your skin with the knowledge that it is not DOING this to you, but is telling you something important, instead. Make small changes and be consistent. Try things for 3 weeks at a time, rather than 3 days. Keep a journal, and take a photo without makeup once a week, so you can see change.


  • Don’t touch your face all the time. Only when you are washing it or applying product with clean hands. 
  • Handle your facial skin gently. If you exfoliate, do it gently! And resist exfoliating when your skin is red and angry.
  • Apply your facial products first, then your body products. The body products use heavier oils, and you don’t need them on your face if you have PD or acne.
  • If your face gets red after washing/applying products (most PD will look worse immediately after washing), try doing your routine only at night for a while. Then your face has all night to soak up the products, and should look more calm when you wake.
  • Don’t wear makeup unless you have to, at least while your skin is angry looking.
  • Try a mask of raw honey (but not the solid kind that is hard to spread) a couple times a week. Wash first, then apply honey and leave for 5-10 minutes. I do this in the steam of the shower, so the honey is almost getting “steamed” into my skin. Rinse very thoroughly.
  • If you are going to choose the antibiotic route, oral antibiotics are probably the way to go – the topicals seem to irritate the skin and you are more likely to give up on them.
  • Lastly, if your dermatologist recommends a steroid cream or lotion (most steroids end in “-one” like cortisone), ask if he or she is aware that steroids are the leading cause of perioral dermatitis. It’s okay to be an educated patient!!

Hope this helps, and please email us at skincare@osmiaorganics if you have other questions about perioral dermatitis or about how to use our products (see the chart below). We get a lot of emails, but we will get back to you, usually within 2-3 days.

With love and patience from us to you, 

Sarah + The Osmia Crew


Osmia Products Recommended for Perioral Dermatitis (all are available in sample and full sizes, and three of them come together in this kit, also available in sample and full sizes):

Black Clay Facial Soap

Dead sea mud and black clay provide a mineral infusion for the skin, and help balance oil production. This product seems to help many people who suffer from PD, and is the first product we suggest trying in your PD routine.

Active Gel Toner This aloe-based toner gel provides a layer of healing hydration. It is to be used as a middle layer, not a top layer, and should be added to the routine last, after you have introduced the Black Clay Facial Soap and the Purely Simple Face Cream.
Purely Simple Face Cream A very simple, light lotion with a higher percentage of water than some lotions, this aloe-based treatment provides gentle hydration without sitting heavily on the skin. This is the second product we recommend adding to your PD routine.  
Spot Treatment This potent blend is for specific spots, and should be used sparingly, especially if the skin is very inflamed. It is NOT for all-over use on the skin, but may be applied to red bumps 2-3 times per day to see if they respond to the anti-inflammatory essential oils. 


    Hello. Can the face cream be used on children – 6 years old?

    Ruby on September 09, 2016

    Hi, thank you for this site! Have you heard of people going for years (or longer) without any more flare ups of PD?

    Ariel on March 17, 2016

    Thanks for all your useful information on PD. What kind of products would you recommend for somebody like me who suffer from allergy and atopic dry skin in conjunction with PD and hence have to avoid all essential oils and need thorough mouisture for the parts of the face (and body) that are not infected with PD? Face oils work so great for my dry skin but I realise now that they might have contributed to the PD (together with steroid creams). Should I simply use different products for different parts of the face (not use face oil around nose and mouth where the PD is)? Also I am wondering if the RMS concealer I use can trigger the PD since it is oil-based?


    Mette Larsen on February 04, 2016

    Thank you so much for addressing PD in such a calm manner! I am having my first episode and it is really severe. Just ordered two sets of your sample size soothing package as , so far, my skin will have nothing to do with anything topical or soapwise with the exception of Aquaphor, which is probably not the best thing to be putting on it. For me, the rash looks and feels like a burn and the pain is quite severe. Do you have any advice re: pain? I’m just taking Advil but that isn’t really cutting it. And my dermatologist (I live in Mexico, and I’m not 100% confident in this dermatologist – not because she’s Mexican but I think her focus is on selling fillers) now has me on methotrexate. Pretty extreme. Anyway, thanks for the information and advice. I’m doing some online shopping to have a friend bring me some items – hopefully some makeup I can tolerate as I can’t afford to be hiding in my house during “high season” here. I’m also a Colorado girl who ran away from her first career (law) to a surprisingly fun second one (real estate in the Mayan Riviera!) – my skin may be confused by the climate change on top of everything else. Fingers crossed I can ease my symptoms with your stuff!


    Kim on January 25, 2016

    Thank you a million times over for addressing PD on Osmia Organics’ blog! After developing mild PD at age 36, I found your products as I frantically tried to educate myself about it online. I now use your Black Clay bar soap in addition to the Active Gel Toner and my PD issues have definitely decreased, except for occasional hormonal flare-ups. Also, because of other skin issues I have, I am unable to wear perfume without breaking out in hives. Your essential oil fragrances are the first scents I’ve been able to wear, and not react to, in years…I love smelling pretty again! I really appreciate your tips here, especially regarding specific products like sunscreen and makeup (areas I’ve had difficulty with). So much self-experimentation takes place as a person deals with PD and it’s wonderful to have products and a resource I know I can trust!

    Danielle on March 09, 2015

    @april There are three products in our Soothing Starter Set that could help with your symptoms. We always recommend ordering the sample sizes first, because every person is different, and the products won’t work for everyone! But they seem to help a great majority of people, so the samples are a great way to find out if you’re one of them. It sounds like you’re taking action to help yourself get on top of the situation, and for that you should be proud! Small changes, over time, make big differences! Good luck, and email us on the site if you have specific questions. Thanks!

    Sarah Villafranco, MD on October 20, 2014

    I have (unknowingly) had a mild case of this condition around my nose and mouth for 15 years and have been treating it with clindamycin / benzoyl peroxide as prescribed by my doctor. Usually I will have a flair up, then I will use the cream for a few weeks to a month… the condition will lessen or go away completely for 6 months… then the cycle continues. Just recently I have started to notice a few small bumps around my left eye, and now my right. This is freaking my out so I have started to dig for solutions. That is how I found your website and all your great info. I use generic toothpaste, Only wash my face with water and use Clinique face cream. On a regular day I will wear mascara, and under eye concealer and maybe a bit of liner… and drink at least two cups of coffee a day (graveyard shifts).

    I will try some small changes: The jason Seafresh Deep Sea Spearment Toothpaste, stop wearing makeup for the majority of the week, and I’ll try tea for three weeks and go from there. My skin is quite dry, do you have a recommendation for skincare?

    Thanks again for all the great info!

    AK :)

    April on October 18, 2014

    Hi there sara, my name is liliya and I just purchased a sample of your black clay soap and simple face cream. I was diagnosed with a mild case of PD. I have been going nuts for about four months trying to figure out what this rash like curse that occurs around my mouth and under my nose. About two weeks ago i spoke with a dermatologist online and he recommended that i use bioderma sensibio cleanser and biafine emulsion, on top of taking beta carotene. It has been two weeks and already i have seen a drastic change from what it looked like two weeks ago. I have been on your website before, but now had the urge to sample out your products after reading such great reviews from PD sufferers. My face has gotten a lot better, but i am stil upset with some redness and the dots very faintly still appear under my nose. I have taken all the steps in eliminating SLS, fluoride toothpast, and gluten. I am hoping that with the cleanser and cream and your newly purchased products, i am hoping to get rid of this for good. Is there a chance that i can cure this once and for all and finally be able to fully smile and feel confident? Thank you for your blogs and information, i am eager to try these products and see how they help my face and skin feel less irritated and red and warm.

    liliya kuzmina on August 13, 2014

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