What is going on with my lips??
Is it an allergy? Acne? Rosacea? Or….is it perioral dermatitis???
By Marie Leger, MD PhD
I remember being a first-year dermatology resident at Bellevue Hospital in New York City. I presented a patient who I thought had rosacea to Dr. Doris Day. She walked into the room, examined the patient, and walked out with a smile. “Periorificial dermatitis!” she said with aplomb.
Dr. Day is a fellow New York City dermatologist and beloved NYU alum. At that time, she taught NYU residents weekly at New York’s public hospital Bellevue, alongside Dr. Alvin Friedman-Kien (one of the first doctors to describe AIDS in the 80s), Paul Frank (another brilliant NYC dermatologist), and Dr. Mary-Ellen Brademas (former swimsuit model and wife of a former president of NYU). In between caring for the city’s most well-heeled residents, they would come in weekly and help us treat freelance writers, recently arrived immigrants, people needing care on Bellevue’s prison floor and Riker’s patients for outpatient dermatology care.
I had never heard of perioral dermatitis, or POD, before Dr. Day taught me about it. In the years since, I see it all the time, especially since the pandemic started. It is a relatively common cause of rashes around the mouth and eyes. With its telltale pink bumps, often perfectly lined up in the nasolabial folds (the groves extending from the corners of the nose to the corners edge of the lips), its little triangles alongside the nose, its tendency to almost touch the red of the lips but not quite, its propensity to make perfect little bumps around the eyes—I have also learned to spot it across the room.
What causes this very weird skin condition? There is no simple answer. Topical steroids are thought to be a common cause--but my patients almost always emphatically say they have not been using any steroids, topical or otherwise. Sometimes I can find other obvious triggers—inhaled steroids for sinus issues, a new retinol cream, maybe masks at work—but to be honest, as often as not I don’t find a trigger. There is also some speculation that infectious organisms—like candida, demodex mites, or fusobacteria are responsible. Some studies suggest that more occlusive skin care regimens can exacerbate POD—for example in one study, patients using foundation, moisturizer, and night cream together increased the risk of getting it by 13-fold. Skin barrier dysfunction may also play a role. Studies have implicated increased transepidermal water loss in patients with this condition, suggesting that moisturizer may help. So, does moisturizer hurt or help? How can you cover your breakouts without making them worse? It can be tricky. I’m often helping my patients with this condition experiment with their regimens to find the best approach.
Drs. Emily Milam and Arielle Naglar, dermatology professors at NYU, recently published a study on perioral dermatitis. (Fun fact—Dr. Levin and I trained with them. All the New York dermatologists know each other!!) Their study shows that diagnosed cases went up between 2019 and 2020, as did mask use, and they speculate in their paper that there is a correlation. I think they are right, based on my experience over the last few years. They further extrapolated that the cause may be microbiome disruption with masks, increased nasal sprays for congestion, and emotional stress.
Treatment for perioral dermatitis usually involves a combination of prescription creams, sometimes an oral anti-inflammatory medication, and a revamping of your skin care regimen. Vascular lasers can make the redness go away faster if you are in a hurry. If an allergy is suspected, your physician may recommend patch testing, a kind of allergy testing that often identifies problem products affecting the face. Pre-pandemic I used to tell people “This will likely go away forever” and a course of doxycycline and sometimes some creams would usually do it. But in the last few years, I have seen oddly persistent POD that lingers or disappears just to come back again a few months later. Sometimes getting POD under control can be an ongoing battle—but with time and patience we can usually help.
Have you ever had periorifical dermatitis? Any insights or theories as to what caused yours? Please chime in on our Instagram page!