Perioral dermatitis is not considered to be a fungal or bacterial infection. While some studies suggest an association of perioral dermatitis with fungus and bacteria, we don’t yet have solid proof to confirm that these are the causes of perioral dermatitis.
What is perioral dermatitis?
Perioral dermatitis is a common skin condition that affects the skin around orifices or openings, most commonly around our mouth and that is the reason, it is called perioral dermatitis.
However, it can also affect areas around the eyes, nose, and genital areas.
Perioral dermatitis presents as a red scaly rash with papules, pustules, or vesicles and is often associated with a burning sensation.
Associated factors
From years of research, we know the following facts about perioral dermatitis:
- It is most commonly seen in young females, 20-40 years of age.
- It is strongly associated with the use of topical steroids.
- It is also associated with the use of oral and inhaled steroids.
- Hormones tend to play some part in it.
- Contact with some products like toothpaste with fluorides and dental fillings can lead to it.
- Heavy cosmetics or multiple layers of thick products can lead to its flare.
Coming on to the infectious part of this disease!
Is it fungal?
Perioral dermatitis is not considered a fungal infection. There are a few studies that suggest an association between perioral dermatitis and Candida albicans.
Candida is a fungus and, in these studies, this fungus was found in lesions of perioral dermatitis. However, it is not clear whether it really causes perioral dermatitis.
While there is a theory suggesting that an overgrowth of Candida may contribute to the condition, we do not have definitive proof to support this. Also, the most commonly recommended treatments for perioral dermatitis do not include antifungals.
Should you use antifungal creams?
Over-the-counter antifungal creams like Lotrimin (clotrimazole), Monistat (miconazole), or ketoconazole (Nizoral shampoo) are often used for various skin rashes including perioral dermatitis.
However, it’s important to remember that, quite often, such medications can actually exacerbate the underlying condition.
In addition, many antifungal creams are combined with steroids like hydrocortisone, which can further worsen this skin condition.
Also, we do not have any research data showing the effectiveness of these treatments for perioral dermatitis.
If you are considering using these products, make sure to consult your doctor and follow their guidance. In some cases, they may take skin scrapings and examine them under a microscope to rule out any fungal infection.
Is it bacterial?
Perioral dermatitis is not considered a bacterial disease. Fusiform bacteria, like Candida, have been found in lesions associated with perioral dermatitis. However, their presence doesn’t necessarily mean they are causing the condition.
It is a common misconception that because perioral dermatitis is often treated with oral antibiotics, it must be a bacterial infection. While antibiotics do kill bacteria, they also serve an anti-inflammatory role. This means they help calm the underlying inflammation, leading to an improvement in the condition.
Therefore, without solid proof, we cannot definitively classify perioral dermatitis as a bacterial disease
Treatment options
Instead of relying on treatments that do not have substantial evidence behind them, it’s best to stick to what is known to be safe and effective.
There are several steps one can take to calm down perioral dermatitis. These include:
- Stopping the use of steroids.
- Avoiding occlusive skin care products.
- Not using harsh skin care products like acids and retinoids.
- Protecting the area from the sun.
Common treatments for perioral dermatitis include metronidazole and erythromycin. Sometimes, azelaic acid is used, which is also available over the counter.
In addition, oral antibiotics – specifically tetracyclines, which include drugs like doxycycline and minocycline – can be prescribed. These are broad-spectrum antibiotics, but they are also effective in treating inflammatory skin conditions. Note that these are also used to treat rosacea.
For pregnant women, oral erythromycin is usually the treatment of choice.
Read more: Best Products for Perioral Dermatitis and The Ordinary Products for Perioral Dermatitis.
Key points
Perioral dermatitis is neither a fungal skin condition nor a bacterial disease. The exact cause of perioral dermatitis is still not completely clear. However, we do know that it is strongly associated with the use of steroids.
A few studies have found Candida albicans, a type of fungus, and fusiform bacteria in lesions associated with perioral dermatitis. However, their mere presence does not necessarily mean they cause the condition.
It is important to note that one should not use anti-fungal creams to treat perioral dermatitis without the guidance of a healthcare professional.
Related posts:
- Is perioral dermatitis contagious? & Perioral dermatitis vs Cold sore
- Perioral Dermatitis vs Acne: How to Tell the Difference
References
- Tolaymat L, Hall MR. Perioral Dermatitis. [Updated 2022 May 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
- Bradford LG, Montes LF. Perioral dermatitis and Candida albicans. Arch Dermatol. 1972 Jun;105(6):892-5. PMID: 4555327.
- Oehlschlaegel G, Düngeman H, Schnabel P, Lagally G. Zur Bedeutung von Hefeinfektionen in der Atiopathogenese der perioralen Dermatitis [Yeast infections in the etiopathogenesis of perioral dermatitis]. Hautarzt. 1971 Nov;22(11):489-91. German. PMID: 5126577.
- Oakley A. Tetracyclines. DermNet.
Disclaimer: This blog post is for information purposes only and does not replace medical advice.