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Perioral Dermatitis

By: @drmelissa.co

Perioral Dermatitis (PD) describes the inflammation of the skin around the mouth (peri- meaning “around”, and oral referring to “mouth"). It typically presents as a red, itchy and swollen rash. PD most commonly affects females age 20 to 45, and can affect children as well. PD is often misdiagnosed as acne or rosacea.

PD occurs because the skin around the mouth has fewer sebaceous (oil) glands, meaning there is less oil production. Because of this, this skin is more prone to disruption caused by skincare products, environmental and lifestyle factors, as well as internal factors. Skin that is in close proximity to a mucous membrane like the mouth, eyes, or nose is also more vulnerable because of the diverse and sometimes skin-harming microbes that live in the mucous membranes.

Skincare products and practices, as well as lifestyle and environmental factors become problematic and potential causes of PD when they degrade the acid mantle of the skin, especially in areas with fewer sebaceous glands. The acid mantle is an incredibly important layer or film that lives on the surface of the skin, acting to keep moisture in and harmful microbes and pollution out. Without this layer, the skin will be more vulnerable to irritation. There can be a disruption in oil production and microbial balance of the skin, and can cause the immune system to dysfunction. Products that can make the skin vulnerable to PD include retinoids, stripping cleansers, acids, exfoliants, products that contain preservatives, fragrances or essential oils, and occlusive creams, makeup or SPF. Other offenders include medications like topical, nasal or oral corticosteroids, dental products containing fluoride or bleaching agents, and invasive procedures like lasers, micro-needling, or peels.

Internal factors that influence PD include but are not limited to: poor elimination, the health of the gut, increased levels of emotional stress, a diet high in processed foods and/or preservatives, nutrient deficiencies, food sensitivities or allergies, insulin resistance, birth control, pregnancy and postpartum, menopause, lack of or too much exercise, and poor sleep. There are usually a variety of internal and external factors at play.

Once the skin is compromised by any or multiple of the above factors, the surface environment is primed for inflammation and can become a host to harmful bacteria found in the mouth. These microbes can cause an imbalance of the lipid layer of the skin leading to dryness and a red, flakey appearance.

Depending on the severity of the PD, treatment duration can vary; typically the more severe the PD, the longer it will take to restore the health of the skin barrier and resolve symptoms. Unfortunately, conventional treatments do not have a high success rate and PD involves an individualised, multifactorial approach to heal. Here are a some of the strategies that can be considered alongside individual treatment:

- Assess current skincare and makeup: remove products with fragrances and essential oils, exfoliants and harsh retinoids if applicable. Use gentle, well-formulated products only.

- Avoid intensive skincare practices including peels, micro-needling and lasers until the skin has completely stabilised at minimum.

- Remove fluoride-containing oral care products and begin oral rinses 1 to 2x per day, gargling with warm salt water for 2 to 5 minutes.

- Yoghurt masking daily over clean skin using a full-fat, unflavoured and organic yoghurt for 30 minutes, and spot treat with a thin layer of Manuka honey to follow overnight.

- Low inflammatory diet, omitting processed sugars and alcohol for at least 30 days or until the skin heals. The elimination of gluten, eggs, and dairy may be considered (topical application of yoghurt masks is okay).

- Support healthy bowel movements by consuming at least 45g of fibre and 2L of filtered or spring water daily at minimum.

As always, it is helpful to speak with an ND or functional MD who can assist in identifying potential underlying causes of PD, including viral infection, gut dysfunction, thyroid imbalance, among others. Your practitioner can also assist in crafting an individualised skincare regime that is suitable for your unique skin needs.

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