Perioral Dermatitis vs Acne: Why Treating It Like Pimples Will Make It Worse

If you’ve developed small red bumps around your mouth, nose or eyes that sting, flake, or persist despite your regular skincare routine, there’s a strong chance you’re dealing with perioral dermatitis. It may look like acne, but the underlying mechanisms are completely different. And using acne treatments can significantly worsen the condition.

What Is Perioral Dermatitis?

Perioral dermatitis is a chronic inflammatory skin disorder that presents as clusters of erythematous papules or pustules, often accompanied by burning, itching, and flaking. It most commonly affects the perioral region (around the mouth), but can also appear around the nose and eyes (perinasal and periocular dermatitis).

It is considered a barrier and microbiome dysfunction condition, rather than a sebaceous or follicular disorder like acne. The skin’s innate immunity becomes dysregulated, leading to a cascade of inflammation and increased trans-epidermal water loss (TEWL).

What Causes It?

Perioral dermatitis often results from chronic irritation or suppression of the skin's immune response, which eventually leads to hypersensitivity. The condition is multifactorial in origin and is commonly triggered by:

• Topical corticosteroids, including over-the-counter hydrocortisone and prescription-strength steroids
• Over-cleansing and the use of harsh foaming or exfoliating products
• Occlusive skincare and cosmetic products that impair barrier function
• Fluoridated toothpaste, which can cause perioral inflammation via mucosal absorption
• Environmental stressors or emotional stress, which elevate cortisol and alter skin immunity
• Long-term or repeated use of antibiotics, which disturb the skin’s natural microbiome

What begins as mild irritation can progress into persistent inflammation when the skin’s stratum corneum is compromised and its microbial diversity is reduced. When this barrier is disrupted, the skin reacts more aggressively to otherwise harmless stimuli.

Why It Is Not Acne

Unlike acne vulgaris, which is driven by excess sebum, retention hyperkeratosis, and Propionibacterium (now Cutibacterium) acnes, perioral dermatitis is not a clogged pore issue. It does not begin in the follicle, and there is usually no comedonal activity (whiteheads or blackheads). Attempting to treat perioral dermatitis with ingredients like benzoyl peroxide, salicylic acid, or retinoids often exacerbates the condition. These actives may be effective for comedogenic acne, but they strip and inflame already compromised skin in dermatitis.

This is why clients often report worsening after applying traditional acne products. The skin barrier, already impaired, cannot tolerate exfoliants or actives that increase cellular turnover or reduce oil. The inflammatory load intensifies, the microbiome becomes more imbalanced, and symptoms escalate.

The Path to Resolution

Healing perioral dermatitis requires a shift in strategy. Instead of drying or exfoliating, the focus must be on restoring barrier integrity, calming cutaneous inflammation, and rebalancing the skin microbiome. You are not treating infection or congestion. You are repairing a dysfunctional skin-immune response.

This involves identifying and removing triggers, simplifying the skincare routine, and using products that nourish and protect the epidermal barrier.

The Roccoco Protocol for Perioral Dermatitis

Our recommended recovery routine is designed to restore homeostasis in the skin:

Ruby Crystal Cleanser
A non-foaming, anti-inflammatory cleanser that purifies without stripping. Supports detoxification while preserving the lipid matrix of the stratum corneum.

Hydrating Treatment Essence
Delivers essential minerals, prebiotics, and hydration to soothe inflammation and re-establish microbial harmony. A vital step for rebuilding moisture balance.

Ceramide Booster
Reinfuses the skin with barrier-critical ceramides and lipids to seal the skin and prevent further TEWL. Improves structural integrity and reduces hypersensitivity.

Rescue Balm
Provides a second-skin occlusive shield that calms burning, itching, and redness. Ideal for restoring comfort and accelerating recovery in the acute stages.

Hydrating Mask
A peptide-rich, soothing overnight treatment that reduces inflammatory signalling and replenishes moisture reservoirs. Especially effective post-flare or during skin recovery.