Perioral Dermatitis: Bumps Around the Mouth and Steroid Creams
Perioral dermatitis is a rash of tiny red or skin-coloured bumps, sometimes with small pus spots and fine flaking, around the mouth, nose and occasionally the eyes, often with a clear rim of skin right next to the lips. Its most common link is steroid cream on the face. The key fact that confuses everyone: when you stop the steroid, the rash usually flares before it gets better.
Quick facts
- Looks like: clusters of small bumps around the mouth and nose folds, mild burning or tightness rather than strong itch.
- Common triggers: steroid creams, including steroid-laced “formula” and fairness creams; steroid nasal and inhaler sprays; heavy creams; some toothpastes and cosmetics.
- First step: “zero therapy”, stopping almost everything on the face.
- Expect: a flare in the first week or two after stopping a steroid.
- Timeline: doctor-led treatment usually runs 4 to 8 weeks.
Is the rash around my mouth perioral dermatitis?
The pattern is quite specific. Tiny bumps, all about the same size, sitting in the smile lines, chin and around the nostrils. The narrow strip of skin touching the lips is often spared. It may burn or sting, especially with washing or products. Adults and children can both get it.
Look-alikes include acne (blackheads and bigger pimples), rosacea (more on the cheeks with flushing), seborrheic dermatitis (greasy flakes in the nose folds; see our seborrheic dermatitis guide), lip-licking eczema, and fungal infection (see ringworm and daad). A doctor can usually tell by looking.
What causes it?
Steroid creams: the big one
Reviews of the medical literature point to topical steroid use on the face as the strongest known trigger. Sometimes it is a prescribed cream used for too long. Very often in South Asia it is a mixed or “formula” cream from a beauty shop, or a fairness cream with a hidden steroid. Our article on whitening cream dangers explains how to spot those. Steroids initially make the rash look better, so people keep using them, which feeds the cycle.
Other sources of steroid on the face
Steroid nasal sprays and inhalers, especially with a face mask or spacer, can bring it on too. So can steroid eye drops overused around the eyes; see steroid eye drop risks.
Products and habits
Thick night creams and occlusive balms, foundations and heavy sunscreens, and in some people fluoridated or strongly flavoured toothpaste may play a part. Heat, wind and UV light can worsen an existing rash.
The cream that seemed to fix the rash is often the reason it keeps coming back.
What is zero therapy?
It sounds too simple, but it is the first step dermatologists recommend, and it can clear mild cases on its own.
- Stop all facial products: cleansers, serums, foundation, night creams, scrubs and any steroid cream (with your doctor’s guidance if it was prescribed).
- Wash with lukewarm water only, morning and night, and pat dry with a clean towel.
- If very dry, use a small amount of a bland, fragrance-free, light moisturiser. Avoid thick ointments.
- Sun protection: shade, a cap and, if needed, a light gel or liquid sunscreen.
- Toothpaste: try a plain, non-whitening, mildly flavoured toothpaste and rinse around the mouth afterwards.
- If you use a steroid inhaler or nasal spray, don’t stop it. Rinse your mouth and wipe the face after each use.
- Keep going for at least two weeks before judging.
Write it down before you strip back
Before zero therapy, photograph every product you have been using on your face, including that “special cream” from the bazaar. Take the photos to the doctor. Ingredient lists and pack names help them spot a hidden steroid quickly, which changes how they plan the next weeks.
Why it flares after stopping steroid cream
Facial skin that has had steroids for weeks or months has been held in a suppressed state. Remove the steroid and the inflammation rebounds, often within days. The rash looks redder, bumpier and more uncomfortable, and many people panic and restart the cream. That restart is what keeps the cycle going. A flare for a week or two is expected; it is a sign of withdrawal, not failure.
For strong steroids used for a long time, doctors sometimes taper by switching to a milder cream first, or use a non-steroid cream, to soften the rebound. That is a decision for the doctor, so tell them exactly what you used and for how long.
How doctors usually manage it
If zero therapy alone isn’t enough, doctors may prescribe a non-steroid cream or gel, or a course of an antibiotic taken for its anti-inflammatory effect. Treatment typically lasts 4 to 8 weeks, sometimes longer, and stopping too early is a common reason it returns. Children are treated with options suited to their age. Without treatment, perioral dermatitis can drag on for months.
See a doctor rather than self-managing if the rash is spreading, is near the eyes, is painful or blistering, appears in a young child, or keeps returning. If a doctor prescribed a steroid for this or another condition, ask how to come off it rather than stopping suddenly. Never stop a steroid inhaler or nasal spray for asthma or allergy on your own; rinse and wipe instead and discuss it at your next visit. Avoid any face cream that doesn’t list its ingredients, and don’t apply a new steroid cream to “calm” the flare.
Perioral dermatitis questions
What is the rash of small bumps around my mouth?
Clusters of tiny bumps around the mouth and nose, sparing the lip edge, often point to perioral dermatitis. A doctor can confirm it and rule out acne, rosacea or fungal infection.
What is the treatment for perioral dermatitis?
Start with zero therapy: stop facial products and steroids, wash with water and use only a bland moisturiser. If that isn’t enough, doctors may prescribe non-steroid creams or an oral course.
Can steroid cream cause perioral dermatitis?
Yes, it is the best-known trigger. Steroids may seem to help at first, but the rash flares when they wear off or are stopped.
Can fluoride toothpaste cause a rash around the mouth?
In some people, toothpaste ingredients may irritate the skin around the mouth. Switching to a plain, non-whitening paste and rinsing the face afterwards is a reasonable step.
How long does perioral dermatitis last?
With proper care, many people improve over 4 to 8 weeks. Without it, the rash can linger for months, and stopping treatment early invites a return.
Can children get perioral dermatitis?
Yes, often linked to steroid creams, nasal sprays or inhalers. Children should see a doctor, who will choose age-appropriate treatment.
Why is the rash around my nose and mouth getting worse after stopping cream?
That is the typical steroid withdrawal flare and usually settles within a couple of weeks. Don’t restart the cream; talk to a doctor if it is severe.
Can I wear makeup with perioral dermatitis?
It is best to stop makeup during zero therapy. Once clear, reintroduce light, non-greasy products one at a time.
Is perioral dermatitis contagious?
No. It is an inflammatory skin reaction and cannot spread from person to person.
More skin guides are in our Skin & Beauty section, and winter skin barrier advice lives in our eczema and winter moisturiser guide.