Perioral Dermatitis vs Acne: How to Tell the Difference

Key points

Perioral dermatitis usually affects the skin around the mouth and nose, while acne can involve any area of the face.
Perioral dermatitis is usually seen in young adult females, while acne is seen in both males and females.
The appearance of the red, scaly rash characteristic of perioral dermatitis is different from various types of acne lesions.
Perioral dermatitis is treated with oral and topical antibiotics, while acne is treated with retinoids, benzoyl peroxide, or antibiotics.

Both perioral dermatitis and acne can lead to red spots on the face. In fact, these conditions can sometimes be confused with each other.

However, perioral dermatitis and acne are due to different causes and their treatment varies. Treating perioral dermatitis like acne can aggravate it.

But how are they different and how to tell what you are dealing with? Here are some features of these skin conditions that may help you!!

1. Who gets it?

Perioral dermatitis is almost always seen in adult females (in around 90% of cases) in the age group 20-40 years. You can see it in other age groups or gender too but it’s uncommon.

Acne on the other hand is seen both in men and women. It is usually seen in teenagers around puberty and young adults.

2. Causes

Perioral dermatitis

The exact cause of why perioral dermatitis occurs is not known. Multiple internal or environmental factors are associated with it. These include:

Topical use of steroids.
Inhalers with steroids.
Hormonal changes.
Skin care products with heavy texture.
Dental fillings.
Toothpaste with fluorides or sulfates especially sodium lauryl sulfate.

Acne

There are four main factors behind acne:

Excess sebum or oil production.
Plugging of pores by dead skin cells.
Inflammation.
Proliferation of bacteria (Cutibacterium acnes).

Acne occurs due to the blocking of our hair follicles aka pores. Oil glands in our skin are attached to hair follicles. These glands secrete sebum which freely flows out of the pores to lubricate our skin and prevent dryness.

These small openings can get blocked due to excess sebum and the accumulation of dead skin cells. Excess sebum secretion can be due to hormones. This is the reason why we see acne in teenagers.

These blocked pores can be open on the surface leading to blackheads or may be closed leading to closed comedones.

In some cases, these can get inflamed or infected, leading to pimples that appear as white bumps with surrounding redness. If the inflammation goes deep, it can form nodules or cysts.

Stress, certain medications like lithium and steroids, and foods with high glycemic index may make the acne worse.

3. Location

Perioral dermatitis

Perioral dermatitis is seen around the mouth. In some cases, it may involve areas around the nose or eyes (periocular dermatitis). In rare cases, it may involve genitalia.

It predominantly involves areas around openings and that’s why it is called periorificial dermatitis.

Acne

Acne is found in areas rich in oil glands. The most commonly involved areas are:

Face
Neck
Chest
Upper Back
Shoulders

4. Symptoms

Perioral dermatitis

It 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.

Acne

Acne can present with different types of lesions and you can see them on various parts of the face. They are usually not localized around the mouth or nose as is perioral dermatitis.

Often people with acne on the face, also have acne on other parts of the body like the chest or back. The types of acne are:

Noninflammatory include:

Blackheads – Small bumps open on the surface with a black center.
Whiteheads – Small bumps closed on the surface (white or skin-colored).

Inflammatory include:

Papules – Small red bumps.
Pustules – Small red pimples with pus.
Nodules – Painful lump deeper in the skin.
Cysts – Painful lump deeper in the skin with pus.

In addition, acne can leave behind scars (icepick, rolling, boxcar).

5. Contagious or not?

Both acne and perioral dermatitis are not contagious.

6. Diagnosis

Both perioral dermatitis and acne can be diagnosed by a doctor after examining the lesions. If any other cause or infection is suspected, your doctor may take a sample from the lesions.

7. Treatment

Treatment of both these conditions is very different. While some perioral treatment products may help acne too, some may not be beneficial. On the other hand, many acne treatments are harsh and can aggravate perioral dermatitis.

Perioral dermatitis

Since topical steroids are one of the strongly associated factors, one needs to stop using them. If you are using over-the-counter soothing lotion, make sure it doesn’t have a steroid like hydrocortisone.

Over-the-counter products with sulfur or azelaic acid may be beneficial.

Mild cases are usually treated with topical antibiotics like erythromycin and metronidazole. Other topical treatments include calcineurin inhibitors like tacrolimus.

For more severe cases, oral antibiotics may be prescribed. Doxycycline (tetracycline) is often used to treat it.

In addition, one should avoid:

Heavy or occlusive skincare or makeup products.
Strong actives like exfoliating acids
Skincare products with potential irritants or allergens like essential oils, fragrances, or dyes.
Toothpaste with fluoride or sodium lauryl sulfate.

Acne

Acne treatment will depend on the severity of the lesions.

Several over-the-counter products with salicylic acid, azelaic acid, benzoyl peroxide, or retinoids can help acne.

If your acne doesn’t respond to them, it’s best to see a doctor to prevent the worsening of acne and prevent acne scarring which can be hard to treat.

The prescription topicals include:

Topical antibiotics like erythromycin, and clindamycin.
Retinoids like Retin-A or tretinoin, adapalene.

In some cases, oral medications may be needed. These include:

Combined oral contraceptive pills.
Antibiotics – Tetracycline (minocycline, doxycycline) or a macrolide (erythromycin, azithromycin).
Antiandrogens like spironolactone.
Oral isotretinoin (Accutane) in severe cases.

Other treatments include chemical peels, light therapy, or steroid injection.

Topicals that can help both acne and perioral dermatitis

Antibiotics like erythromycin
Sulfur
Azelaic acid

8. Key differences

Perioral dermatitis

Seen predominantly in young adult females (20-40 years).
Cause unknown (topical steroid use is strongly associated with it).
Rash leads to redness, papules, and pustules.
The rash is usually located around the mouth, in a few cases around the eyes or nose.
It may be associated with burning, but usually not painful.
Treated with topical or oral antibiotics.

Acne

Acne is usually seen in teenagers and young adults in both males and females.
It is caused by the blockage of our pores or hair follicles.
Can appear as whiteheads, blackheads, papules, pustules, nodules, or cysts.
Can occur on the face, chest, or back.
Deep-seated lesions like cysts or nodules can be painful.
Treated with retinoids, benzoyl peroxide, salicylic acid, antibiotics, and hormonal pills.

9. 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 sulfate and fluoride-free toothpaste.

To prevent acne:

Don’t touch or squeeze your acne lesions.
Remove your sunscreen or makeup at the end of the day.
Take a bath or wash your face after exercise or sweating.
Use an OTC face wash with salicylic acid.
Reduce or manage your stress.

Summary

Perioral dermatitis and acne are common skin concerns that can lead to red bumps on the face. However, the location and appearance of these can help in differentiating them.

Topicals used to treat acne can irritate perioral dermatitis or worsen it. So, it is important to identify these and use the right treatment products.

If you are not sure what is causing the red bumps around your mouth or on your face, it’s best to see a doctor for proper diagnosis and treatment.

Read more:

References

Tolaymat L, Hall MR. Perioral Dermatitis. [Updated 2022 Sep 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
Kraft J, Freiman A. Management of acne. CMAJ. 2011 Apr 19;183(7):E430-5. doi: 10.1503/cmaj.090374. Epub 2011 Feb 28. PMID: 21398228; PMCID: PMC3080563.

Disclaimer: This blog post is for information purposes only and does not replace medical advice.