Treatment of Perioral Dermatitis

General Treatment Principles

Avoid potential irritants including greasy creams, which might facilitate the development of folliculitis due to their occlusive properties 1
Apply hypoallergenic moisturizing creams if skin is dry 1
Avoid topical antibiotics like neomycin and bacitracin as they can cause allergic contact dermatitis themselves 2

Avoid topical steroids as maintenance therapy as they can worsen the condition long-term, even though they may provide temporary improvement 1
Do not apply greasy creams for basic care as they might facilitate the development of folliculitis due to their occlusive properties 1
Avoid manipulation of skin lesions due to risk of infection 1
Be aware that topical retinoids may be irritating and systemic retinoids may aggravate xerosis and increase itch sensation 1

The American Academy of Dermatology recommends avoiding greasy creams and occlusive products, and discontinuing fluorinated toothpaste if suspected as a trigger, as part of the treatment approach for perioral dermatitis 3

Gentle cleansers may be used for mild cases of perioral dermatitis, as part of a "zero therapy" approach, which involves complete avoidance of all facial products except gentle cleansers 3

Discontinuing greasy creams and occlusive facial products helps prevent folliculitis development and reduces worsening of perioral dermatitis in affected patients. 4
Refraining from manipulating skin lesions lowers the risk of secondary infection in individuals with perioral dermatitis. 4

Topical metronidazole is especially beneficial when oral therapy (e.g., tetracyclines) is contraindicated for adults with moderate‑to‑severe perioral dermatitis, providing effective disease control. 4
Avoiding topical retinoids prevents irritation and aggravation of perioral dermatitis symptoms, supporting better tolerability of the treatment regimen. 4
Continuous use of topical steroids as maintenance therapy should be avoided because, despite temporary improvement, it leads to long‑term worsening of perioral dermatitis. 4

Patients should avoid hot blow‑drying of the hair and other sources of heat or friction applied to the perioral area, as these factors can exacerbate the condition. 4