Shortly after my 30th birthday, during a particularly stressful time at work, I found myself with a breakout of epic proportions. (Like, call-in-sick-so-nobody-has-to-see-me bad.) So I recruited the big guns: glycolic acid face wash, prescription retinol, and antibacterial spot treatments.
But no matter how many new acne products I tried—and I tried a lot in my panicked state—my skin just kept getting bumpier and more inflamed, especially on the lower half of my face. A dermatologist prescribed me a steroid cream, which helped to a certain extent, but things never fully cleared up. For the next five years, my chin was perpetually red and covered in pimples of varying size and severity, which I blamed on stress and hormones
That is, until I went to see a new dermatologist at the end of last year, who took one look at me and told me that I wasn’t actually dealing with acne at all. Instead, she gave me an unfamiliar diagnosis: perioral dermatitis.
Peri-what? “Perioral dermatitis is inflammation around the mouth that appears as small, red bumps that can be itchy or uncomfortable,” explains New York City dermatologist Dendy Engelman, MD, who notes that it’s often mistaken for acne. “This is very common in my practice—[I see] at least 8 patients a day with this condition.”
No one actually knows what causes perioral dermatitis, which is found most often in women under 45, or why it only tends to affect the lower half of the face. But experts have some theories, starting with what’s in our cosmetic bags. One small, Australian study found that the more beauty products in one’s routine, the higher the incidence of perioral dermatitis. Harsh ingredients are another contributing factor. “From a topical perspective, overly stripping the skin and then applying improper products following can trigger inflammation,” says San Francisco esthetician Kristina Holey. This makes perfect sense, in my case—I was using so many acids, oil-control masks, and anti-bacterial agents to combat breakouts that it’s no wonder my skin revolted.
“[Perioral dermatitis] is very common in my practice—[I see] at least 8 patients a day with this condition.”—Dendy Engelman, MD
Lasers, microneedling, and peels often contribute to inflammation as well, says Holey, as can stress, lack of sleep, and eating inflammatory foods. And those aren’t the only things that can trigger a perioral dermatitis outbreak, says Dr. Engelman. “Misuse of steroid creams, toothpaste with fluoride, birth control, rosacea, or bacterial or fungal infection [can play a role,]” she says. “Plus, environmental factors like sun, heat, and wind can also cause a flare-up.” (Kind of a miracle that we don’t all have it, right?)
Given that there are, oh, a bajillion things that might contribute to perioral dermatitis, it can be kind of hard to figure out how to make it go away—in this case, treatment isn’t one-size-fits-all. Holey recommends working with a specialist, who can help you pinpoint the internal and external factors that could pertain to you. “Then, you can strategize a therapeutic skin care regimen, dietary, and supplement plan to help restore balance to the skin and body,” she says.
Dr. Engelman adds that a good place to start is to avoid fluoridated toothpastes, take a daily probiotic, and use a sulfur face wash. “If you’re still flaring after that, see a dermatologist for prescription treatments like Soolantra, Finacea, MetroGel, or Oracea,” she says.
In my case, I’ve seen a complete turnaround in my complexion from replacing my super-intense skin care arsenal with just five products: Thylox sulfur bar soap ($4), Marie Veronique’s Pre + Probiotic Daily Mist ($40), and the Intensive Repair Serum, Soothing B3 Serum, and Barrier Restore Serum ($290) from Holey and Marie Veronique’s microbiome-balancing collection, which is formulated to be especially effective for perioral dermatitis. Once I did this, it took about six months for my chin to stop looking like I was exfoliating it with sandpaper. But I’ve learned my lesson: When it comes to skin freak-outs, less is always more.
If you’re riding the perioral dermatitis train, you might want to try one of these skin products with 10 ingredients or less. And, for the love of avocado toast, stop touching your face.
My goal is to be your Age Management Retreat. Ladies, I speak your Age! I'm 59 and have encountered, or will soon, the aging skin issues we 'd like to avoid.