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woman looking at breakout in bathroom

When Your Breakout Isn’t Acne

if it’s not a pimple, what is it?

A few weeks before my wedding, I groaned when I looked in the mirror. There was a little breakout on my chin. At least the wedding isn’t this week, I thought. But my skin seemed worse in the days that followed. I remembered reading about people who went to the doctor for a cortisone shot when they got a pimple ahead of an event. But I hated to wait until right before the wedding to try to treat it.

I left it alone for a while, hoping it would resolve. No such luck. I decided to make an appointment to see if I could get something prescription-strength that would make the breakout go away.

I was almost apologetic when Physician Assistant Beth Palazzetti of Southlake Dermatology came in the exam room. “My breakout isn’t that bad,” I explained, “but I don’t want to take a chance on having acne in the photos.”

Palazzetti had me pull down my mask. Within a second, she told me, “You don’t have acne. That’s a rash.” She plucked a brochure about perioral dermatitis off the wall. I’d never heard of it. Palazzetti prescribed low-dose antibiotics, and my skin cleared up before the big day. The wedding photos were saved!

I figured there had to be others out there trying to treat breakouts that might actually be perioral dermatitis. So I connected with Palazzetti for more information that we could share with our readers.

What exactly is perioral dermatitis, and how do you know that you might be dealing with that versus acne? Perioral dermatitis literally means “rash around the mouth.” It’s a rash that can form around the nose, mouth and even the eyes. Another term for it is periorificial dermatitis, or “rash around the orifices.”

Sometimes it’s asymptomatic, but often patients complain of itching or burning, especially when using facial products. We most often see it in women and adolescents.

The cause is unknown, but it seems to be worsened by steroids—creams or inhaled for asthma or allergies; certain toothpastes with fluoride, tarter control or cinnamon flavoring; some cosmetic products, and physical factors like weather—heat, cold, too much sun. It is often mistaken for acne. Any acne or rash that doesn’t resolve with over-the-counter medications should be evaluated by a dermatologist.

How common is perioral dermatitis? It is quite common. I see it in clinic several times a week. It is often misdiagnosed.

What would happen if someone is treating perioral dermatitis with acne medications? Trying to treat perioral dermatitis with acne medications can make the rash worse and cause it to spread.

Why are antibiotics a typical treatment for perioral dermatitis? Does that mean a bacterial infection causes the rash? Actually, there is rarely any infection with perioral dermatitis. The type of antibiotics that we use to treat it are anti-inflammatory. We can often prescribe low-dose antibiotics, which are not strong enough to treat an infection.

What are the considerations for treating the rash with oral antibiotics versus a topical antibiotic? Should patients push for both for the fastest healing? It depends on the severity of the rash. By the time patients get to my office, they often have tried many things that have made their rash worse. I often prescribe both topical and oral to help them see faster improvement.

Is there a norm for how long it takes the skin to clear? Even with appropriate treatment, it can take several weeks to months. Never as fast as my patients want it to clear!

I understand that perioral dermatitis can’t be “cured.” But are there things someone can do to make it less likely to come back? People who are prone to perioral dermatitis often have sensitive skin. I would recommend they stick with soap-free gentle cleansers and moisturizers. Avoid scrubs and alcohol-based products. And never use a topical steroid on the face, as this definitely can worsen perioral dermatitis. Ask your dermatologist for skincare recommendations to help to avoid flareups.

Image courtesy of iStock.