This little-known skin condition ruined my life… how I treated it

That favourite Kiehl’s face oil of yours? Bad. That silky Elemis cleansing balm you have been using for years? Worse. That ‘miracle’ hydrocortisone cream your mate swears by? Catastrophic. And don’t even get me started on stress, all of which combine to trigger my seasonal nemesis: perioral dermatitis, the skin condition that behaves with the diplomatic grace of a wasp in a wine glass.

Let’s get one thing straight: perioral dermatitis is NOT acne. It may look and act like acne, but its not. Acne spots are deeper, larger and tend to erupt along the classic oily T-zone; forehead, cheeks and jawline. Acne can also scar. Perioral dermatitis, thankfully, does not.

It is also not eczema. Or rosacea. It’s an unholy hybrid of all three that affects thousands of people – especially women between 20 and 45 – and often begins as a mysterious little cluster of bumps that appear out of nowhere, settles in and slowly starts to spread across the above areas. Left untreated (or treated with the wrong thing), it starts to burn, itch and tighten (yep sexy), and is made exponentially worse by the plethora of luxe lotions and potions you have been using to help your skin.

And because it looks deceptively like acne, many GPs misdiagnose it as a general breakout and prescribe topical steroid creams or abrasive cleansers that only aggravate the situation. My face looked like a charred pizza after a round of hydrocortisone steroid cream – a quick dab soothed the redness for a day, then it rebounded with the enthusiasm of a toddler denied toys.

And then there’s the emotional side. Physically, perioral dermatitis stings like someone is massaging your face with sandpaper. Mentally, it’s a slow descent into 2am scrolling through Mumsnet forums trying to find answers before convincing yourself you will simply never look normal again. I cancelled social plans, avoided photos entirely, and turned my winter scarf into a makeshift balaclava as I tried to hide my chin and nose walking down the street. I also cried. A lot.

Around week two (pictured) after finishing the steroids my GP had prescribed and seeing absolutely no progress, I threw money at the problem and booked an emergency appointment at the recommended Harley Street Dermatology Clinic. I’d enquired about a dermatology referral through the NHS, but the waiting list was six months plus. I couldn’t wait that long – not unless everyone agreed to dim the lighting until spring.

Within five minutes of chatting to the dermatologist I had a proper diagnosis: perioral dermatitis. I was told that I must go on a skin diet and kiss goodbye to my favourite and divine-smelling products immediately. No more heavy moisturisers. No essential oils. No exfoliants. No make-up on the affected area.

This is because rich emollients cause more inflamed lesions. Argh. No more Elemis Miracle Balm for me. I was also informed that peroral dermatitis is an underlying condition rather than a one-off rash. It is something to be managed and kept at bay for life with the gentlest of skin routines.

I was prescribed a 12-week daily course of oral Tetralysal (300 mg), which treats everything from bacterial infections to severe acne, and a big bottle of Dermol 500 as a cleanser, which is a leave-on moisturiser and unfragranced soap substitute. I took the private prescription to the chemist and it costs just shy of £100. Ouch. But I finally had a name for the angry mess that had been living on my face, and the correct products to treat it.

Now it’s worth noting that some people improve quickly. Others (hello) take six to 12 weeks and have several existential crises along the way. But stick with it. Improvement, although sometimes slower than watching paint dry, does come.

What was prescribed for me is also not going to work for everyone.  For those dealing with a particularly fiery flare, dermatologists may recommend: metronidazole, azelaic acid, clindamycin – none of which sound remotely glamorous, but all of which actually help and are far better than crying in the mirror and thinking coconut oil is the answer.

Living with perioral dermatitis isn’t fun or attractive, but learning how to manage it has given me a strange sort of acceptance. There’s something reassuring about knowing what your skin needs-and what it absolutely does not. And while flare-ups may still come and go, they no longer knock me sideways or have me glued to Mumsnet. With the right routine, the right advice, and a little patience, my face has finally returned to something resembling normalcy. I’ll take it.

The best ways to beat perioral dermatitis

Stop the steroids   

The biggest trigger of all. Ditch hydrocortisone and any steroid creams unless medically essential. They only soothe the condition in the short-term. Then dramatically rebound.

Simplify everything

Strip your routine back to the bare bones: gentle cleanse, light moisturiser, mineral SPF. Done. Perioral dermatitis thrives on overcomplicated skin routines.

Avoid heavy products

No thick creams, balms, face oils, petroleum jelly, or anything described as ‘rich.’ Sorry. Let your skin breathe.

Go fragrance-free

Perfume in skincare = irritation. Stick to boring-but-soothing formulas.

Check your toothpaste

Switch to a fluoride-free option if you suspect it’s a trigger – it’s surprisingly common.

Put exfoliation on pause

No scrubs, no acids, no retinoids. If it tingles, stings, or promises ‘radiance,’ avoid it for now.

Hands off

No picking, no ‘just checking it in the mirror.’ Touching it only helps to spread it. Trust me.

Keep the area makeup-free

At least during the height of a flare-up. Makeup traps heat and bacteria, making things much worse. And replace your make-up sponge regularly when you are applying it again. 

Consider prescription help 

Topical metronidazole, azelaic acid, pimecrolimus, or a short course of oral antibiotics can calm stubborn cases fast.

Treat it as an underlying condition

Perioral dermatitis is something you manage long-term.  Don’t relapse with perfumed creams once it starts to clear up. Gentle routines and trigger-spotting are your best defence.