Navigating Periorificial Dermatitis. Insights and Management Strategies for Adults and Children

Periorificial dermatitis is a broad term encompassing various skin conditions that affect the face, including perioral dermatitis. (1,2). 
 
Today’s article aims to shed light on periorificial dermatitis, its types, symptoms, and triggers, with dedicated insights for both adults and children. Treatment and care as well as the impact of nutrition on its management will also be explored. 
 
What is periorificial dermatitis? 
 
Periorificial dermatitis is a common, yet often misunderstood skin condition, presenting as rash around the orifices or openings of the face and on the forehead. The different types are: 
 

• Perioral dermatitis: This is the most common form, manifesting as a rash around the mouth and sometimes spreading to the nose and chin areas. It is more common in women and can be made worse by the application of topical steroid creams, thick moisturisers, and certain cosmetic products. 
• Periocular dermatitis: This type affects the skin around the eyes, presenting similar symptoms to perioral dermatitis. Due to the delicate area around the eye, it requires careful and specific treatment approaches. 
• Perinasal dermatitis: Less common than the other types, perinasal dermatitis appears around and sometimes within the nostrils. Like its counterparts it features red, inflamed bumps and may cause discomfort or irritation. 

 
What are the common symptoms? 
 
This condition can be both physically uncomfortable and emotionally distressing.  Common symptoms in adults include: 

• Redness and rash across one or more of the facial regions.
• Itching or burning sensation.
• Dryness and peeling. 
• Inflamed pustules

 
In children periorificial dermatitis is more challenging to diagnose due to overlapping symptoms with other paediatric skin conditions including atopic, contact eczema or even impetigo. 
 
Common triggers
Common triggers include, but are not exclusive to:

• Prolonged topical steroid use
• Skin care products with harsh or irritating ingredients
• Environmental factors such as humidity, wind, UV exposure and pollution
• Hormonal changes and oral contraceptives.
• Stress. 
• Bacterial or fungal overgrowth.

 
Treatment and Care
Medical diagnosis typically involves a clinical examination with a GP or dermatologist. The primary approach to care involves identifying and eliminating triggering factors, such as specific skincare ingredients, environmental irritants or even foods.  
 
For adults, medical treatment often includes topical immunomodulators, antibiotics or mild corticosteroids, however studies have shown that with this form of dermatitis the best course of action is often to leave well alone and not apply any creams at all.  
 
Recommendations focus on restoring the skin barrier along with a gentle, hypoallergenic skin care regime, alongside stress management and dietary changes. 
 
Paediatric management focuses on gentle cleansing and application of hypoallergenic moisturisers to maintain skin hydration. Avoiding known irritants, allergens and intolerances is key, especially if the child has an atopic terrain. I recently worked with an infant whose perioral dermatitis resolved up to 90% with the elimination of one trigger food. 
 
The role of nutrition in managing periorificial dermatitis
 
There is no specific diet that focuses on modulating periorificial dermatitis, but nutrition can play a pivotal role in skin health, providing the correct nutrients to modulate inflammation, support natural immune function and strengthen both the gut and skin microbiomes.   

• Omega 3 Essential Fatty Acids: found in oily fish, flaxseeds and chia can help modulate inflammation, benefiting skin conditions that are characterised by redness and irritation.
• Pro and Prebiotics: gut health is intrinsically linked to skin health. Supporting your gut by eating a daily portion of both probiotics (healthy bacteria), and prebiotics (the foods that the probiotics love) is key. Probiotics include live yogurt, kefir, kombucha, kimchi, fermented vegetables such as gherkins and even sourdough bread. Prebiotic foods include garlic, onions, asparagus, and Jerusalem artichokes. 
• Antioxidant-rich foods: fruits and vegetables are packed with antioxidants that combat oxidative stress, a skin inflammation contributor. Eating a Rainbow of different coloured fruits and vegetables each day provides a good breadth of naturally produced antioxidants. You can click on the link for my free Rainbow Foods Resource. 
• Avoiding triggers. As individuals we can be less tolerant to certain foods. This can be temporary depending on our gut health or can be more long-lasting. Identifying which foods might be triggering an inflammatory response is important. Whilst some common ones include sugar, dairy, egg and gluten, others may be something you wouldn’t have even imagined. Keeping a Food and Symptom diary can really help keep track and identify triggers. You can download your free Food & Symptom Diary here. 
• Hydration: with dermatitis we often think about moisturising our skin using creams, lotions, and potions, but hydration starts from within. Ensuring that you drink regularly throughout the day supports skin hydration and function, assisting in the natural repair of the skin barrier. 

 
Periorificial dermatitis can be challenging but can also be managed with the right approach encompassing medical solutions with lifestyle and nutrition modifications.  Understanding the different types of periorificial dermatitis and recognising the importance of nutrition as the foundation to skin health are key steps towards achieving clearer, healthier skin. 
 
If you haven’t yet been diagnosed it’s essential to consult with your GP or dermatologist for an accurate diagnosis. Remember, nutrition is just one piece of the puzzle, even if it is a vital one. 
 
Skin/Gut Masterclass – Tuesday 19th March 2024 at 12pm UK time. 
 
If you are interested in hearing more about the skin/gut connection I am holding a Masterclass this coming Tuesday, 19th March at 12pm UK time. If you register and are unable to attend, you will receive a recording of the event on Wednesday 20th March. You can register here.
 
References

1. Searle T, Ali FR, Al-Niaimi F. Perioral dermatitis: Diagnosis, proposed etiologies, and management. J Cosmet Dermatol [Internet]. 2021 Dec 1;20(12):3839–48. Available from: https://doi.org/10.1111/jocd.14060
2. Balić A, Vlašić D, Mokos M MB. The Role of the Skin Barrier in Periorificial Dermatitis. Acta Dermatovenerol Croat. 27(3):169–79.