Acne Masterclass with Dermatologist Dr. Teo Wan Lin
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Dermatologist Pro Tip:
I have pimples around the mouth, is this perioral dermatitis or hormonal acne?
Not all “hormonal acne” around the mouth area is acne!
Non-dermatologists as well as a laypersons often confuse a condition known as perioral dermatitis for acne, because the condition can often appear like pimples around the mouth. However, that really isn’t really acne. Let me break down the words for you. Medical terms can sound quite complex but they are really well understood when you break it down.
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What is perioral dermatitis?
Perioral is a descriptive term of the location of this skin condition and it means around the mouth. Another term that is frequently used interchangeably with this is periorificial. Your orifices on the face would be the areas where your eyes, your nose, your ears, and your mouth are.
How does it look like?
Perioral dermatitis also is known as periorificial dermatitis, a form of scaly red rashes that can occur around these areas, often appearing like pimples around the mouth. The term dermatitis really refers to any rash that is flaking, red, and has symptoms of sensitivity, dryness. Some people may be associated with tightness as well as irregular bumps on the surface of the skin. Perioral dermatitis is a troubling condition that is often confused for hormonal acne when the condition manifests similar to pimples around the mouth.
TikTok Tip #1: Check out this #LearningIsFun Series by Dr. Teo Wan Lin
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In this TikTok video under the #LearningIsFun series, Dr. Teo shares “What kind of makeup should you be using if you are acne-prone? Well, the good news is I do have some tips for you. Essentially mineral makeup is more beneficial for skin especially if it is free of bulking agents such as bismuth oxychloride which can sometimes give rise to a cut glass sensation on the skin of sensitive skin users. This is very common in individuals who find themselves having irritation despite using pure mineral makeup.
The reason why pure minerals are actually the gold standard of makeup constituents when you have sensitive skin is because these tend to have low allergenicity which means that it does not trigger off skin irritation. This is especially if you suffer from skin conditions including acne while you are on treatment. It is also critical that you are using effective topical acne treatment. It is useful to bear in mind that your acne cream should not just be used over your acne bumps but an effective way to use your acne creams is actually to apply it over the entire acne-prone area twice a day. Now this is referring to acne creams that have minimal or low irritation potential.”
What are the key clinical differences between someone who has perioral dermatitis vs. another who has acne?
Acne itself can sometimes be associated with background redness and flaking as well as skin sensitivity but is generally not so. Acne is best characterized as having painful bumps with whiteheads and blackheads as well as cysts. Pimples around the mouth with such characteristics are true acne pimples. Individuals with perioral dermatitis, on the other hand, may have acne-like bumps on the surface of the skin but their primary complaint will be that of redness around the affected area or in the background. Individuals who use topical anti-pimple medications i.e. benzoyl peroxide and prescription medications like retinoids may also develop a perioral dermatitis-like rash around where they are treating their acne bumps. A careful clinical history will avoid confusion.
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What is the cause of perioral dermatitis?
In a lot of conditions in dermatology (including perioral dermatitis appearing like pimples around the mouth), we have a term known as idiopathic. Idiopathic means that there is no clearly defined cause but we are able to identify trigger factors. The key difference is that these trigger factors can be everyday items that most people have otherwise no issues being exposed to but will trigger off a flare in an individual who is predisposed to perioral dermatitis. I used the term predisposed – what does that mean?
TikTok Tips #2: Check out this #LearningIsFun Series by Dr. Teo Wan Lin
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In this TikTok video under the #LearningIsFun series, Dr. Teo shares “Can dirty pillowcases cause acne? Well, the truth is that if you are acne-prone then you ought to be careful the type of surfaces your skin comes into contact with. This is because bacteria can easily infect existing acne papules causing secondary infection, leading to the development of cyst and in severe cases, abscesses.
Well, we all come into contact with bacteria but for acne sufferers, it is very important for you to minimise touching of your face. Also, if you are able to upkeep certain standard of hygiene in terms of your bedding as well as even your mobile phone if you hold it to your face, that will possibly reduce your chance of acne flare up.
The pillowcase is actually quite interesting because its the surface that our skin comes into contact with for at least 7-8 hours everyday, all our lives while we are sleeping. There has been a study in Israel focusing on the use of a biofunctional textile incorporated copper nanoparticles that has the ability to inhibit the bacteria that causes acne and they trialed this on acne-prone individuals who reported a positive benefit from using these biofunctional textile.”
A predisposition means that the individual is for some reason more prone to developing certain conditions. Based on our understanding of current dermatology research, predispositions are primarily genetic. This explains why your friend may be exposed to the exact same environment, the same product as you but only you develop a reaction.
If you suspect you have perioral dermatitis, what should you do?
Do first distinguish perioral dermatitis appearing like pimples around the mouth from true acne based on the characteristics we discussed above. If the dermatitis is very mild, meaning that it’s been there for less than a month and it’s affecting a very localized area and is otherwise not bothering your child, then you may practise the following home treatment measures first.
TikTok Tip #3: Check out this #LearningIsFun Series by Dr Teo Wan Lin
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In this TikTok video under the #LearningIsFun series, Dr. Teo shares “There can be both hormonal acne and maskne occurring at the same time. Besides that, we know that certain over the counter acne treatments such as salicylic acid, benzoyl peroxide can actually result in a form of irritant contact dermatitis that can cause red itchy bumps. Sometimes these bumps is confused with acne itself (a non-dermatologist may misdiagnose perioral dermatitis as pimples around the mouth). Visit a board certified dermatologist for an accurate diagnosis as well as evidence-based therapy.”
Dermatologist Pro Tips for Managing Perioral Dermatitis
- Stop application of any pimple or blemish creams
- Switch to a gentle cleanser that is suitable for sensitive skin. There are several dermatologist-recommended brands.
I personally recommend a medical-grade honey formulation that helps to stabilize the skin flora in addition to moisturizing the skin.
- Switch your toothpaste out to a mint SLS-free toothpaste.
The perioral region, where one may mistake dermatitis for pimples around the mouth, is one that is affected by beverages that we drink, our saliva. In the case of an individual who may be sensitive to the menthol component in toothpaste, it can certainly make it worse.
- Invest in a good ceramide-based moisturizer
We use the Multi-CERAM cream which is a combination of synthetic as well as plant-based ceramides. This helps to repair the skin barrier to treat the dermatitis aspect of it.
If you’ve tried the above home treatments for a week or two and you find that your symptoms are still persistent or getting worse, then you may need to book in to see an accredited dermatologist.
Now, there are some known trigger factors of perioral dermatitis.
If you are diagnosed with perioral dermatitis, your dermatologist will recommend the following:
Essential Skincare Advice for those with Perioral Dermatitis
- Stop all non-essential skincare including your moisturizer and sunscreen for the period of treatment
While these are essential components of any skincare regime, in an individual with perioral dermatitis, it seems that these can make the condition worse.
- Do not switch around your skincare
By default, we do not recommend the constant trying of various types of skincare products but rather sticking to a dermatologist-recommended brand. The constant exposure to various ingredients may conflict with one another and may cause sensitization overtime. In perioral dermatitis, this constant exposure to various preservatives sensitizes, and fragrances in the skin may lead to worsening or flare-ups of the condition.
If your condition is severe enough, your dermatologist will recommend a course of oral medications. In my practice, 90% of all my patients with perioral dermatitis are started on a course of oral anti-inflammatory antibiotics. The reason is that treatment with topicals is extremely limited given that most topicals, even those which are medicated and indicated for the treatment of other types of dermatitis can lead to a flare-up of perioral dermatitis.
One thing to bear in mind is that perioral dermatitis itself does not magically disappear. Rather, if you have been treated for perioral dermatitis also be prepared that the condition may flare up again. However, 95% of all my patients with perioral dermatitis have good control. That doesn’t mean that they are discharged from follow up or that they do not have any medical treatment going on. We usually treat the acute face with oral medications. We thin it off after a minimum of six weeks and maintain it with certain topical medication which is tolerated by them.
What moisturisers can I use if I have perioral dermatitis?
The entire process is a very careful process whereby we introduce skincare items one by one. In terms of moisturizers that are safe for individuals with perioral dermatitis, I always stick to two types of acids. They are acids in nomenclature but they are not true acids, but rather perform a moisturizing function. Hyaluronic acid also is known as sodium hyaluronate in its purest form.
The molecular weight of hyaluronic acid has come under scrutiny in the last 2-3 years because various companies have acted on the scientific evidence that what we call multi molecular weighted hyaluronic acid molecules have better efficacy in terms of absorption and long-term effects on the skin. The other acid that my patients use is the polyglutamic acid which is present in our mineral booster. The mineral booster is formulated with predominantly polyglutamic acid. Polyglutamic acid itself is 4-5 times more efficacious than hyaluronic acid in terms of its ability to hold its weight in water.
Why do I focus on these molecules for the hydration of perioral dermatitis-type skin?
The reason is that the absence of oil in these formulas are generally better tolerated by individuals with this condition. Now, makeup is generally a no-no for individuals with this condition. Remember, less is more if you have been diagnosed with perioral dermatitis, which sometimes may appear similar to pimples around the mouth. Do check with your dermatologist if you have further questions.~All Topics, Acne, Skincare Tips