Periorificial dermatitis (also known as perioral dermatitis, when around the mouth) has become increasingly common over the past 10–15 years. Conventional treatment involves topical antibiotics or anti-inflammatories and oral antibiotics if needed. The vast majority of cases are linked to external environmental exposures or topical irritants that trigger an inflammatory response around hair follicles in the perioral, nasal, or periocular areas. And so it makes sense that primary treatments should be removal of irritants and natural support for internal imbalance.
Common Causes of facial dermatitis:
Prolonged or repeated use of topical steroids
Disrupted Skin Barrier: Over-cleansing, exfoliating, or using irritating products (like alcohol-based or fragranced creams)
Microbial Imbalance: Overgrowth of normal skin flora (e.g., Candida, Demodex mites, or Staphylococcus bacteria). Rosacea-like mechanisms may be involved in some cases.
Hormonal Fluctuations: More common in women aged 20–45, possibly due to hormonal shifts. (e.g., estrogen dominance, cortisol dysregulation)
Food sensitivities: often dairy, gluten, sugar, and eggs
Gut dysbiosis or leaky gut
Histamine intolerance (less common, but can exacerbate flares)
Environmental toxins or allergens (e.g., mold exposure, heavy metals)
Natural Treatments/Supports:
Natural treatments will address the underlying cause of dermatitis - usually by addressing 6 major areas to restore skin health.
Gut Health: Underlying bacterial imbalance, leaky gut, small intestinal bacterial overgrowth (SIBO) and fungal overgrowth (Candida) can all play a role. This can be assessed through exploring your digestive health and promoting regular daily bowel movements. Sometimes advanced GI Mapping can help clarify potential dysbiosis or inflammation in the gut.
Hormone Imbalance: Hormone changes through the ages can cause flares in histamine-like reactions. Estrogen, progesterone, and cortisol—have a direct impact on histamine regulation and mast cell activity. These relationships can explain why some people, particularly women, experience histamine-related symptoms that fluctuate with their menstrual cycle, stress, or hormonal shifts.
Estrogen stimulates histamine release by increasing mast cell activation and histamine release, reducing the activity of DAO (diamine oxidase), the main enzyme that breaks down histamine in the gut and upregulating histamine receptors. In turn, elevated histamine stimulates estrogen production. Skin flares are often worse around ovulation until just before menstruation.
Progesterone calms histamine response by stabilizing mast cells, reducing histamine release and counterbalancing estrogen’s stimulating effect on histamine. Low progesterone is often the culprit in short luteal phases (short menstrual cycles), perimenopause, and chronic stress as it leads to unopposed estrogen and worsened histamine reactions. Symptoms will improve in pregnancy.
Cortisol regulates inflammation and mast cells by stabilizing mast cells and keeping histamine in check. With chronic stress or HPA axis dysfunction, cortisol can become low, leading to heightened responses. Skin will be worse after periods of extreme stress.
An additional consideration is thyroid hormone. Low thyroid hormones may slow down histamine clearance, possibly through effects on gut motility and DAO activity. High thyroid hormones can increase histamine receptor sensitivity.
Some assumptions about hormone clearance can be made based on basic serum hormones run on Day 3-5 of the menstrual cycle. More in-depth testing such as the Dutch Hormone test may help to provide further clarify on how the body is breaking down and clearing hormones.
Food Sensitivities: Food sensitivities can contribute to dermatitis, including periorificial and other forms (like eczema), by triggering systemic immune and inflammatory responses that show up in the skin. This connection happens even when the skin is not the site of direct contact with the food. Food sensitivities often result from or contribute to increased intestinal permeability ("leaky gut"). When the gut lining is compromised, partially digested food proteins (like gluten, dairy casein, or soy proteins) can cross into the bloodstream. The immune system treats them as foreign invaders. The skin, being a detox and immune-responsive organ, manifests this systemic inflammation — often as dermatitis.
A Hypoallergenic Diet guided by a health care professional can help to identify triggering foods. A Food Sensitivity Test may also be helpful when food elimination is difficult. Keep in mind that inflammation takes time to cool down. The length of time it takes for dietary changes to be effective can be up to 12 weeks.
Liver function: Impaired detoxification.
Stress & sleep: Affect immune and hormonal balance.
Environmental factors: Mold, toxins, allergens.
Adjunctive natural therapies may include herbal medicines or nutrients that target skin health by calming the immune system, building health gut bacteria, optimizing detoxification and lymphatic drainage and protecting the skin barrier. These might include omega-3 fatty acids (EPA/DHA), Vitamin D3, Vitamin A, Zinc, Evening Primrose Oil etc.
Natural treatments focus on addressing the underlying cause. This includes removing all potential topical irritants from shampoos, conditioners, creams, lotions, eye drops in addition to assessing the environment for allergens, molds etc. Gentle versions of skin care products can be discussed. Other tools like water filters and air purification systems or humidifiers can also be helpful.
Common Triggers & Aggravators
Facial creams, cleansers or cosmetics (especially heavy or occlusive ones)
Fluoridated toothpaste
Inhaled or nasal corticosteroids
Makeup removers and wipes
Sodium lauryl sulfate (SLS) in cleansers
Eye drops with preservatives (e.g., benzalkonium chloride)
These (and other skin care or cosmetic products) usually cause irritation because they contain:
Surfactants and Detergents:
Sodium lauryl sulfate (SLS) – very common and highly irritating
Sodium laureth sulfate (SLES) – slightly milder but still disruptive to skin barrier
Cocamidopropyl betaine
Preservatives:
Parabens – methylparaben, propylparaben (less irritating but controversial)
Formaldehyde releasers: DMDM hydantoin, Quaternium-15, Imidazolidinyl urea, Diazolidinyl urea
Methylisothiazolinone (MI) and methylchloroisothiazolinone (MCI) – extremely sensitizing
Phenoxyethanol – less harsh but still problematic for some sensitive individuals
Fragrance:
Synthetic fragrance (often just listed as "fragrance" or "parfum")
Natural fragrance – essential oils included under this label can still be irritating
FD&C or D&C dyes – artificial colorants
Alcohol:
Denatured alcohol (alcohol denat.)
SD alcohol
Isopropyl alcohol
Exfoliants:
Glycolic acid
Lactic acid
Salicylic acid
Retinoids (retinol, tretinoin)
Occlusives that trap heat and moisture:
Petrolatum (petroleum jelly) – generally safe but can aggravate some cases of periorificial dermatitis
Mineral oil – non-comedogenic but may block pores if skin is inflamed
Silicones (e.g., dimethicone, cyclopentasiloxane) – not irritating for all, but some react
Other Irritants
Propylene glycol – penetration enhancer; irritating for some
Benzalkonium chloride – preservative in eye drops and skin antiseptics
Benzoyl peroxide – drying and inflammatory
Sodium hydroxide – pH adjuster; caustic at high concentrations
Urea (in high concentrations) – hydrating in low doses but irritating at high doses
Natural Triggers and Irritants:
Spices & Botanicals: Cinnamon (cinnamaldehyde), Clove oil, Peppermint oil, Oregano oil, Mustard seed extract
Essential Oils especially if undiluted: Tea tree oil, Lavender oil, Lemon, lime, orange oils (citrus oils), Eucalyptus oil, Frankincense or myrrh, Rosemary oil
Other Natural Ingredients: Raw honey, Apple cider vinegar, Lemon juice, Aloe vera (with additives or from whole leaf), Witch hazel, Propolis (from bees), Lanolin, Baking soda