Perioral dermatitis is not contagious so one cannot get it by touching someone. However, perioral dermatitis can be confused with herpes (cold sores) which is a contagious viral infection.
What is perioral dermatitis?
Perioral dermatitis is a skin condition that results in a bumpy, red rash around the mouth. This rash appears scaly, flaky, and dry, with inflamed papules or small red bumps.
It can also be itchy. In addition to the skin around the mouth, it can also be seen near the nose and around the eyes on the face.
This condition is most often seen in females between the ages of 20 to 40 years. The exact cause behind it is not clear. However, it is associated with the use of topical steroids, fluoride toothpaste, dental fillings, hormonal changes, and certain skincare products. It is usually treated with topical and oral antibiotics.
Is it contagious?
Perioral dermatitis is not contagious, meaning you cannot contract it from someone else, nor can others get it from you. However, it is sometimes confused with herpes (cold sores), which also leads to a rash on and around the mouth.
Therefore, it’s important to differentiate between these two conditions.
Perioral dermatitis vs. herpes (Cold sores)
1. Who gets it?
Perioral dermatitis is predominantly seen in young adult females, making up around 90% of cases, generally within the age group of 20-40 years. In contrast, cold sores affect both males and females of all age groups.
2. Causes
Perioral Dermatitis
The exact cause of perioral dermatitis is not clear. However, it is strongly linked to several factors, including:
- Topical use of steroids
- Steroid inhalers
- Hormonal changes
- Heavy moisturizers or skincare products
- Dental fillings
- Toothpaste containing fluoride or sodium lauryl sulfate
Cold sores
Cold sores are usually caused by the herpes simplex virus (HSV) type 1, though HSV type 2 can occasionally be the cause.
One can contract the virus by directly touching the lesions or sharing items contaminated by the virus, like towels, brushes, and utensils.
Once infected, the virus stays in our body for life. Not everyone who has the virus will have symptoms, but some people do develop outbreaks of cold sores or herpes.
Factors that can trigger an outbreak of herpes include:
- Illness, such as a cold, flu, or fever
- Hormonal changes
- A weakened immune system
- Menstruation
- Excessive sun exposure
- Stress
- Allergies
3. Symptoms – Location and appearance
An important aspect of differentiating herpes and perioral dermatitis is location and appearance.
Perioral dermatitis
Perioral dermatitis usually leads to a rash around the mouth. The rash appears red, scaly, and flaky. One can also see red inflamed bumps called papules. Sometimes, they can be filled with pus called pustules.
The rash can cause a burning sensation. It can also tingle or itch. The bumps do not occur directly on the lips.
The rash can also appear around the eyes or nose. In rare cases, it may involve genitalia. Basically, it occurs around openings and that’s why it is called periorificial dermatitis.
Cold sores
Cold sores lead to painful fluid-filled bumps called blisters on the lips and lip border. Before the rash appears, one may experience a burning or tingling sensation.
This is followed by fluid-filled bumps. These can burst and ooze. They can then crust and scab and finally, the scab falls off.
You can also get lesions between the nose and lips or below the lip on the chin, on the nose, cheeks, or near the eyes.
Similarities in symptoms
- Both perioral dermatitis and herpes can cause a burning or itching sensation.
- Both can lead to bumps around the mouth.
- In both cases, a rash can appear near the eyes or nose.
Differences in symptoms
- Perioral dermatitis does not follow the same phases of healing as herpes.
- Perioral dermatitis does not lead to lesions directly on the lips.
- Most of the bumps in perioral dermatitis are red or filled with pus. Fluid-filled lesions can occur but less often.
- In most cases, perioral dermatitis bumps are not painful in comparison to cold sores.
- Cold sores usually heal in 1-2 weeks. In comparison, perioral dermatitis may take longer to heal (in a few cases months).
4. Contagious or not?
Perioral dermatitis is not contagious while herpes (cold sores) is contagious.
A person with herpes can spread the virus to others. One stays contagious right when the first symptoms of burning appear until the sores heal completely (that is after the scab falls off).
5. Diagnosis
Both perioral dermatitis and herpes are diagnosed based on their appearance, symptoms, and location. In addition, your healthcare provider may review your history.
In the case of perioral dermatitis, if an infection is suspected, your doctor may take a sample.
In a few cases of herpes, your healthcare provider may take a swab to test the fluid for herpes virus.
6. Treatment
Treatment of both these conditions is entirely different as well.
Perioral dermatitis
- One has to stop using topical steroids.
- Azelaic acid may decrease inflammation and redness.
- In mild cases, topical antibiotics like erythromycin and metronidazole may be prescribed.
- For more severe cases, oral antibiotics – tetracycline like doxycycline are prescribed.
- In addition, one should avoid using heavy and occlusive skin care products, strong irritating actives like exfoliating acids, or skincare products with potential irritants like essential oils or fragrances.
Herpes (cold sores)
In healthy individuals, cold sores may heal on their own in 1-2 weeks.
- Over-the-counter balms with benzocaine (like Carmex) may reduce the pain by numbing the area. However, these do not heal the lesions faster.
- Lip moisturizers or ointments may prevent dryness.
- Abreva cream which is available over the counter has an antiviral ingredient that can help in faster healing of the lesions.
- In severe cases or in people with weak immune systems, topical and oral antivirals may be prescribed.
- One should follow good hand hygiene when handling cold sores to prevent the spread of the virus to other parts of the body.
7. Preventive measures
To prevent perioral dermatitis
- Do not use over-the-counter steroids unless instructed by your physician.
- Avoid the use of heavy and occlusive products.
- Use sensitive skin-friendly products.
- Use fluoride and sulfate-free toothpaste.
To prevent cold sores
- Practice good hand hygiene.
- Eat well and get plenty of rest.
- Avoid excessive sun exposure and always use sunscreen.
Key differences
Perioral dermatitis
- Seen predominantly in young adult females (20-40 years).
- Cause unknown (topical steroid use is strongly associated with it).
- The rash appears to have a red base with papules and pustules.
- The rash is usually located around the mouth.
- Usually, the rash is not painful although it can burn.
- It is not contagious.
- Treated with topical or oral antibiotics.
- Takes longer to clear.
Herpes (cold sores)
- Seen in both males and females and can occur in all ages.
- Caused by Herpes simplex virus type 1.
- The rash usually appears on the lips or lip border.
- The rash appears as fluid-filled bumps.
- The rash is painful.
- It is contagious.
- May clear on its own or can be treated with antivirals.
- Usually takes 1-2 weeks to clear.
Summary
Perioral dermatitis is a non-contagious skin rash, while herpes (cold sores) is a contagious viral infection. Both of these can lead to bumps around the mouth; however, herpes may also lead to sores on the lips, unlike perioral dermatitis.
It is important to differentiate between these skin conditions because their treatments are entirely different. If you’re unsure about what’s causing a rash on or around your mouth, it’s best to see a doctor for proper diagnosis and treatment.
Read more:
- The Ordinary Products for Perioral Dermatitis
- Best Products for Perioral Dermatitis: Face Wash, Moisturizer, Sunscreen
- Is Perioral Dermatitis Fungal or Bacterial?
- Perioral Dermatitis vs Acne: How to Tell the Difference
References
- Tolaymat L, Hall MR. Perioral Dermatitis. [Updated 2022 Sep 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
- InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Cold sores: Overview. 2018 Jul 12.
- Saleh D, Yarrarapu SNS, Sharma S. Herpes Simplex Type 1. [Updated 2022 Aug 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
Disclaimer: This blog post is for information purposes only and does not replace medical advice.