How to tell the difference between perioral dermatitis and acne (and how to treat it)

Written by Lucy Partington

Freelance beauty editor Lucy Partington is obsessed with all things skincare, collecting eyeshadow palettes that she’ll probably never use, and is constantly on the hunt for the ultimate glowy foundation.

It’s easy to misdiagnose perioral dermatitis, so if you’ve had an unexplained breakout that you’re struggling to get rid of, read this.

Skin flare-ups can happen to anyone at any time. Whether it’s acne, eczema, psoriasis, dermatitis or something else entirely, there’s often no rhyme or reason why it’s happening – and that’s OK. It happens to the best of us, and the most important thing is that you try not to let it stress you out and make sure it’s treated accordingly.

However, according to consultant dermatologist Dr Emma Craythorne, a lot of her patients are coming into clinic with perioral dermatitis that’s been misdiagnosed as an acne flare-up. As a result, the wrong sorts of products are being used and, unsurprisingly, it’s making things a whole lot worse.

But the thing is, how exactly are you supposed to know the difference when both conditions present themselves in a similar way? We asked Dr Craythorne how to diagnose perioral dermatitis and discussed some of the main causes (believe us when we say the answers may surprise you). Of course, if you’re concerned or confused about your skin, it’s always best to seek out a GP or a dermatologist for professional advice.

What is perioral dermatitis?

In short, perioral dermatitis is a common facial skin problem that is characterised by groups of small, red itchy or tender papules confined to the skin in the lower half of the face, mostly around the mouth. “Some people with perioral dermatitis may only get a few bumps, and their rash may not be very discernible, while others may have many bumps forming a noticeable rash,” explains Dr Craythorne.

What does perioral dermatitis look like?

“The bumps may be skin coloured or hyperpigmented and may appear red or pink in people with fair skin, and some may have white pus inside them,” says Dr Craythorne. “It’s important to note that although they might resemble pimples, the bumps are not the same as acne. However, the rash may look inflamed, with the underlying and surrounding skin appearing red, pink, or flesh-toned.”

Does perioral dermatitis hurt?

Perioral dermatitis doesn’t usually hurt. “The rash can sometimes be itchy though, and some people may feel tightness or a mild burning sensation in the affected skin, which may be dry or flaky,” says Dr Craythorne.

How can you tell the difference between perioral dermatitis and acne?

“Although it can be quite difficult to know the difference between this and other conditions – often perioral dermatitis can go hand in hand with a rosacea diagnosis – it’s important to find out, especially when it comes to differentiating it from acne or eczema, because treatment for those conditions will make perioral dermatitis much worse, and then [you’ll end up in] a never-ending vicious cycle,” explains Dr Craythorne. “However, visible clues include the size of spots and how they are grouped together. There will not be any blackheads in the area, and take note of the location. Perioral dermatitis is most common on the chin, lower corners of the mouth and around the nose area.”

What are the main causes of perioral dermatitis?

While there are no underlying conditions that can cause perioral dermatitis, it’s also not contagious. “The most common cause is topical or inhaled steroids, but other causes include a problem with the skin’s barrier, bacterial getting into hair follicles, an allergic reaction, irritation from a skincare product, irritation from fluoridated toothpaste around the mouth, hormone changes, strong winds and UV light,” says Dr Craythorne.

How should perioral dermatitis be treated?

Most often, perioral dermatitis is treated by what Dr Craythorne calls a ‘null approach to therapy’, which essentially means reducing almost all topical treatment. “Use very basic skin cleansers and moisturisers. I like La Roche Posay’s Toleriane Cleanser, £13.50 and Moisturiser, £17.50,” she says. “After that, to actively treat the area, it will require medical treatment with ingredients like azelaic acid, tretinoin and metronidazole, which are available via Klira, which prescribes customised actives for your skin and ensures they use the correct base for your skin – and in this case, wouldn’t contain any known triggers for perioral dermatitis.”

Main image: Getty

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