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Perioral Dermatitis: An Integrative Approach

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Perioral dermatitis is a skin condition brings great frustration both to those suffering from, and to practitioners who are trying to help manage it.

According to integrative dermatologist and functional medicine doctor, Dr. Michelle Jeffries:

“Perioral Dermatitis is a skin condition with a combination of red scaly patches with small red pimple-like bumps located around the mouth. It can also be located around the nose or eyes. This inflammatory skin condition occurs mostly in adult females and children, however, it can also occur in men. Perioral dermatitis may be triggered by a variety of factors and everyone’s trigger may be different, but here are a few of the most common triggers I’ve seen in my practice:

  • topical steroids
  • inhaled steroids (used for asthma and other respiratory conditions)
  • steroid nasal spray (used for allergies)
  • toothpaste (fluorinated and non-fluorinated) and mouthwash residues that were not rinsed off from skin
  • cinnamon (and less commonly mint) flavored toothpaste, gum, breath mints, etc
  • food additives (color, preservatives, etc)
  • chemical based sunscreens
  • make-up removal wipes
  • food sensitivities and foods that promote gut dysbiosis, the most common food triggers are:
    • nightshades
    • dairy (cow and goat)
    • gluten/corn
    • sugary foods and candies
    • processed foods
    • fried foods”

The conventional dermatologic approach to perioral dermatitis often includes antibiotics, in addition to avoiding the use of topical steroids, harsh scrubs, or heavy occlusives. The American Osteopathic College of Dermatology also points to fluoridated water and oral care products as a potential cause, and recommends avoiding these as well.

Here at the Nutritional Aesthetics® Alliance, we want to bring awareness to the many alternative, holistic, and integrative approaches that have shown promise in managing perioral dermatitis.

Here’s a compilation of integrative tips shared by top integrative and functional skin health practitioners:

From NAA Advisory Board Member, Dr. Georgia Tetlow, MD, ABOIM:

“Perio-oral symptoms can be painful and cause us to feel self-conscious. I believe in searching for root causes, and understanding what our body is telling us, rather than suppressing the symptom. Angular chelitis, or cracks at the angle of our mouth, cracks on the tongue itself, or rash or discomfort around one’s mouth can indicate a B6 deficiency. Consider a micronutrient test at an integrative clinic to get a reliable answer, or take some over the counter pyridoxine! The activated form is affordable and easily found, and is called Pyridoxien-5-Phosphate. A generally safe daily dose is 25-50mg until symptoms are resolved. This is a great support for PMS and hormonal acne as well!”

From dermatologist, Dr. Keira Barr, MD; author of The Skin Whisperer and founder of Resilient Health Institute:

The Skin Whisperer by Dr. Keira Barr

“Perioral dermatitis is a great topic because it is a challenging condition and often requires putting on your detective hat to find the source of the trigger and flares. There often can be more than one contributing factor including disruption of the skin microbiome from either skincare products applied to the skin or from overzealous manipulation of the skin with exfoliation.

Often we don’t appreciate that what we are putting on our skin can be the very thing that is aggravating it including the toothpaste and oral hygiene products we use especially those with cinnaminic aldehyde and sodium laureth sulfate. Other factors to tune into include food sensitivities. Keep a food log, and implement a 2 to 3 week elimination diet if some suspects come to the forefront. Lack of quality sleep, which lends itself to hormonal imbalance and decreased stress resilience, can also play a part. Bottom line is “take notice so you can take action.” If we don’t tune into what we are putting on our skin, in our bodies and our minds, we can’t fine tune the best course of action to heal. P.S. Ditch the steroid cream…helps in the short term, but using it just begs for rebound flares and ongoing frustration.”

From NAA Advisory Board Member, and author of Clean Skin from Within, Dr. Trevor Cates, ND:

Clean Skin from Within by Dr Trevor Cates

“What I’ve found in my practice is that is perioral dermatitis is often related to a food allergy or intolerance. I generally do Food Intolerance testing to determine what the reaction is to. Also, gut dysbiosis issues should be addressed. Topically, using natural salves (such as those made with calendula and comfrey), and working to restore the mild acidity of the skin can help.”

From Dr Sarica Cernohous, DACM, L.Ac, and author of The Funky Kitchen:

The Funky Kitchen by Sarica Cernohous

“The Chinese medicine interpretation of this presentation, of skin redness with raised papules would be a pattern of heat and some dampness, notably in the Yang Ming foot channel (Stomach). Therefore, using medicinals and the foods that clear heat and dampness, and do not further engender it, are really important.

In this instance, it would also be good to do a tongue diagnosis for further corroboration of the presentation. If all signs point to damp heat in the stomach channel, then avoiding sugars, processed and heavy foods, processed dairy, alcohol  and hot spices would be suggested. Consumption of moderate amounts of fresh, cooling foods–and use of medicinals that help support digestive function so the inherent heat of the stomach does not stagnate and lead to damp accumulation–is also helpful. We want to keep things moving along here, for free flow of energy and substance not only in the stomach, but throughout the digestive tract.”

And we close out with more from Dr. Michelle Jeffries:

“Avoidance of what triggered your perioral dermatitis is key.  It may take a few weeks of avoiding the trigger before you see a change in your skin. 
Besides avoiding your known triggers, here are some skincare tips to decrease the inflammation a little faster. 

  • be gentle with your skin and avoid scrubbing the skin 
  • apply topical niacinamide cream to help calm the inflammation
  • apply aloe vera gel to calm inflamed skin 
  • avoid vitamin c serums as some vitamin c serums may aggravate perioral dermatitis
  • be mindful that you are eating foods with skin healing minerals such as zinc, selenium, vitamin a, c, d and e
  • explore your nutrition plan and be sure that includes a rainbow of veggies & fruits, healthy fats, nuts, seeds and healthy protein sources which may include sustainable fish, grass fed meats, poultry

Make an appointment with your dermatologist if you are struggling with improving your rash. There are a number of anti-inflammatory treatment options to explore and add into the above recommendations that will accelerate your healing. Your dermatologist will discuss with you what is the best fit for your condition.”

We’d love to hear from you!

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Is perioral dermatitis something you’ve struggled with personally, or that you see a lot in your skincare or wellness practice? What have you found to be effective? What have you found NOT to be effective?

Please share your thoughts in the comments below!

Want more info from today’s contributors?

Dr. Michelle Jeffries and Dr. Trevor Cates have both done webinars for NAA Members, which are located in the members-only Webinar Library. Click HERE to join today! Dr. Cates and Dr. Cernohous were both teachers for the NAA-sponsored Herbal Skincare Summit, which is available HERE.

*The content in this article is for informational purposes, is not intended to diagnose or treat any disease of the skin, and is not a substitute for medical care. If you have questions about your own skin or health, please consult with your licensed medical practitioner.

**This post contains affiliate links.

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