Peri Oral Dermatitis: Getting to the guts of it!

There is so much more to treating peri oral dermatitis than quick 'Bandaid' fixes. Long-term results come from digging deeper....

I’ve wanted to write about this condition for ages because I see it so much in clients and it’s so commonly misdiagnosed as sensitivity or acne. Peri oral dermatitis (PoD) gets its name because it’s commonly located around the mouth — but it can also occur around the eyes (periorbital dermatitis), between the brows and also around the nostrils. It is seen mostly in women aged 15-45 and it looks pink and unhappy and it can flare up then go into remission. When it does flare up your skin can be intolerant of your usual skin care and it can suddenly feel stingy.

Uneducated doctors can tend to prescribe steroid creams to treat PoD, and this makes it far worse (also be aware that steroids can be in your nasal spray and asthma inhaler). GPs can also tend to prescribe oral antibiotics and these can temporarily clear up PoD but because they don’t address the underlying cause, it often comes back later — sometimes with a vengeance.

I’m going to explain a bunch of important factors that can contribute to PoD. Working with all these factors helps us get to the bottom of it rather than just bumbling about with Bandaid solutions that don’t really address the issue:

Leaky Skin

Leaky skin happens when your skin microbiome is out of balance. This means that the healthy balance of good bacteria on your skin is not intact, compromising your skin's natural barrier. Our good bacteria protect our skin against mites, not-so-good bacteria, pollution, fungus, viruses and other microbes.

When leaky skin happens it leads to inflammation that can pave the road for more chronic skin conditions like dermatitis, acne, eczema, rosacea, and psoriasis as well as premature ageing.

It can feel good when our skin is thoroughly cleansed BUT there’s a big difference between having well cleansed skin and ‘squeaky-clean’ stripped skin. Over cleansing and over exfoliating with things like abrasive rough cleansers, exfoliants and facial buffers can result in us stripping away healthy microbiome, leaving the skin feeling tight and exposed to leakiness. When our skin’s barrier breaks down allergens like dust mites, dermodex mites and bacteria can enter the skin and this leads to even more inflammation and allergic reactions.

Fungal overgrowth

An overgrowth of a fungus called Malassazia is thought to cause PoD. This yeast fungus produces some nasty by-products that cause irritation and inflammation. Malassazia flourishes when the skin’s pH is upset and the fungus chomps away happily at fats and oils (that are protecting our skin) to grow and flourish. It’s important to remember that a yeast fungus can only colonize our skin if our skin is leaky, if we have a compromised immune system and not enough good bacteria on the skin. It’s important to have a sound skin routine prescribed for your skin by a professional (like me!) who can support your barrier function (and provide referrals to help with immune function). Anti-fungal creams don’t replace a prescribed skin routine but they have been known to support the issue if it’s triggered by a fungus.

Gut function

PoD is often a sign of a dysbiotic gut. Our skin and gut microbiomes cleverly communicate and influence each other. It is extremely common for clients showing PoD symptoms to also have an issue with internal candida overgrowth and/or a parasite. If you have a history of antibiotic use you are at higher risk of candida overgrowth. A common trigger for PoD is antibiotics and yet they are so often prescribed for this condition. When I work with clients who have PoD I’ll commonly provide a referral for gut testing via a nutritionist so we can get support for any gut influences right away.

Fatty acid enzymes (EFAs)

A common issue with PoD is the impairment of an important enzyme called delta-6-desaturase. This enzyme is important because it’s very involved in the synthesis of essential fatty acids. Essential fatty acids or EFAS are really important because they are the fundamental building blocks for our cell membranes. In short EFAs are vital to healthy skin cells and if our little enzyme mate delta-6-desaturase isn’t working properly then our EFAs are not forming well either. Zinc, magnesium and B6 deficiencies and insulin resistance can also affect our EFAs. EFA imbalances are so common with clients who have chronic inflammation so when I work with clients who have PoD or inflammation I’ll commonly provide a referral to a naturopath to check in on any genetic deficiencies (including Filaggrin protein deficiencies which causes inflammation) and to support any supplementation.

Food allergies & sensitivities

Allergies or sensitivities to gluten and dairy are really common. Dairy in particular causes inflammation for most of our guts because the breast milk is not aligned with out gut needs —it’s cleverly formulated for baby cows not grown human adults. We are each unique so particular foods that might flare up your POD will be different to someone else. Keeping a food diary can be helpful in noticing common themes. I’m a big advocate of consulting with a nutritionist to help you with this. We all have blind spots and might not identify something a food that’s important (or that we’re really attached to eating).

Stress

Stress is a big trigger for those with PoD. Stress will alter immune function, inflammation, and our microbiomes. Stress and gut inflammation can also impair the skin’s barrier function. Stress can often be a bit of a vicious cycle too. We might have had a stressful period or a stressful incident that has thrown the body out of balance and then when we experience inflammation, which can cause even more stress if we feel self-conscious about our inflamed skin. It’s important to be mindful that we are our own worst critics so go gently with yourself in the skin healing process. No one else is going to be noticing your redness as much as you!

Because stress plays a huge part in so many skin conditions I have the mindfulness library available as well as the option to download mediations. It’s important to see the skin as a friend, rather than foe (this blog post explains this more). Inflammation is always helping us out, telling us that something’s not right, so we can act.

Hormonal changes

There is a rare type of dermatitis known as autoimmune progesterone dermatitis. More often, though, PoD can be aggravated by an imbalance in Oestrogen and Progesterone and it can be linked to changes in the contraceptive pill.

Climate and temperature

Changes in weather can be big triggers. Humidity, heat and sweat can often aggravate the condition. PoD isn’t fond of temperature extremes so spas and saunas are a no-go when it’s inflamed as is very hot or very cold water. Keep your shower and facial cleansing water moderate in temperature.

Toothpaste

Toothpastes can be a trigger for some people with PoD. Fluoride-free and sodium laureth sulphate-free toothpastes tends to keep PoD happier. Sulphates generally can upset the skin so it’s better to avoid them in skincare and cosmetics. All the skincare in the online store is sulphate-free.

Makeup

If you can avoid foundation or cover up on your PoD then do — it’s best not to have makeup on it that could potentially exacerbate it.

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Things to help right away:

Use a non-chemical (mineral) SPF

Use a microbiome treatment

Support the skin’s balance and inflammation with a reputable niacinamide serum

Begin using a probiotic/prebiotic anti inflammatory supplement

Start taking an EFA supplement.

Use a medical-grade anti inflammatory makeup

Schedule a skin consultation with a skin expert to build a supportive skin program for your skin — working from the outside in.

Find a great naturopath and nutritionist to support you — working from the inside out

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