I have had perioral dermatitis 3 times in my life: right after my dad died, the early days of lockdown during the Covid 19 pandemic, and after switching my oldest daughter abruptly to homeschooling with a baby under the age of one.
While the root causes of perioral dermatitis very from person to person (i.e. steroids, hormones, stress), mine seems to be greatly caused by stress.
Perioral dermatitis affects the area around the nose and mouth, while typically avoiding the vermillion border that directly touches the lips. It’s typically characterized as a red rash with small, fluid-filled pustules, and it resembles rosacea and acne. Whenever I’ve had an outbreak, I usually know it’s coming because it has a distinct, pin-point stinging sensation where a pustule will erupt. From there, the rash usually spreads. From my personal observation, it seems to spread after a pustule ruptures and several new bumps will appear close to the first one.
For the first time ever, I found how to heal my perioral dermatitis without a trip to the dermatologist, without antibiotics, and forgoing most of the online recommendations such as using diaper rash cream or occlusive creams to ‘support barrier function’.
*Please note, I am not a medical professional and the information I share is anecdotal to my own experience.
Step 1: Try to figure out the root cause of your case.
If you recently added a topical product (lotions, serums, makeup) – stop using it. After my earlier bouts with PD, as a rule of thumb, I avoid putting many cosmetics in my perioral region for fear of a breakthrough case. Sometimes heavy creams can make PD worse, but also topical steroid creams can cause withdrawal and a flare of PD with it.
And if you’re like me and it cropped up during an extremely stressful period, figure out how to manage your stressors. Personally, I had to remind myself this time around that everything is ‘figure-out-able’, incorporate regular exercise and meditation, and remember that my childs stress is not my own.
Additionally, demodex mites can be a factor (ew, I know). They thrive on sebum, dead skin cells, and hormones in hair follicles. Knowing this, I made sure to thoroughly wash my bedding, wash my face to remove oils, and gently rub a towel over the PD to exfoliate. Using harsher physical methods or chemical exfoliants has only made my PD worse.
Step 2: The topicals.
Many dermatologists recommend focusing on skin barrier health and using things like La Roche Posay’s Cicaplast Baume or even zinc containing diaper creams. While I appeciate the thought on this, any occlusive product has ALWAYS caused my PD bumps to swell up and spread – even topical prescription antibiotic creams. And when the topical antibiotic would fail, I would eventually need an oral antibiotic – and destroy my gut health all in the name of ridding my perioral dermatitis.
The suggestion of diaper cream made me ponder something though – does zinc help heal perioral dermatitis?
I had some zinc capsules in my supplements drawer, so I cracked one open and pat the zinc powder on my perioral dermatitis. To my surprise, the next morning the rash seemed less raised and a little less red. I continued this trial for a few weeks and while I saw improvement, I was not seeing a total elimination of PD. I began to think more outside the box.
If zinc seems to be healing, yet I can’t use a diaper rash cream because it’s too heavy, what other methods of zinc application will help it penetrate deeper into the skin than zinc powder alone?
I found a bar of soap that contains pyrethione zinc, so I began using that 2X/day. I noticed that like the zinc powder, my rash seemed lessened and wasn’t spreading, and this seemed to be working much better than zinc powder. At this point, I felt like I was on the right track, so I needed to find something to further treat the pustules and redness.
I also know that hypochlorous acid sprays are anti-inflammatory and anti-bacterial while being gentle, so I added this one into my routine. Since it’s also antibacterial, if you have an overgrowth of demodex mites (we all have them, but sometimes their populations can get out of control), it can help kill some of the bacteria that the mites are feasting on.
And lastly, to spot treat the pustules and redness, I found this spray. It’s an alternative method of topical zinc that doesn’t have a heavy base like the cream version of this product. I sprayed a cotton swab a few times, and heavily coated the pustules and red areas with this lightweight liquid. It dries down and feels similar to a mud mask. This was easiest to do overnight and while at home as it’s bright white and not really a look I cared to sport in public.
Typically, I reapplied this zinc spray several times a day; it’s how I started seeing the most dramatic results. If I needed to go somewhere during the day, I lightly pat it on with my finger creating a very thin layer that’s not as white. Then I’d cover it with a light dusting of this matte mineral makeup (which you guessed it, also contains zinc). Trust me when I say you don’t want the original formula as it contains mica and will highlight texture. The matte formula flattens the appearance of bumps.
Step 3: Consider gut health.
While there aren’t necessarily concrete studies to back this up, so much of our overall health ties to our gut health. With a bit of curiosity, I decided to eat more fermented foods daily like saurkraut, kefir, kimchi, kombucha, and take a daily probiotic supplement. My thought was if an antibiotic clears PD up, perhaps it’s killing bad bacteria in the gut; instead of killing the bad bacteria (and the good bacteria), perhaps I could try increasing the good bacteria in my gut to crowd out the bad bacteria. While I am not 100% sure how much this factored into my healing, it certainly didn’t hurt!
Healing for perioral dermatitis isn’t immediate. It isn’t even overnight. It took several weeks to stop seeing bumps appear, and when you apply the zinc cream to them, they will crust over. Sometimes the same bump will seem to crust over for several days before disappearing and just leaving some redness. Eventually, the redness subsides, too.
This routine of a pyrethione zinc soap, hypochlorous acid, and then the zinc spray made my perioral dermatitis vanish without a single trip to the dermatologist like my previous cases. Unlike all of the derm recommendations to use heavy cream based products, I trusted my intuition this time, and with a little tinkering discovered that the key to healing my perioral dermatitis was to dry it out; the opposite of what many derms and internet forums recommend.
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Boldly Lauren 
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