Azelaic acid is a naturally occurring dicarboxylic acid found in grains such as barley, rye, and wheat, recognized for its anti-inflammatory and antimicrobial characteristics. Perioral dermatitis presents as a rash commonly appearing around the mouth, nose, and occasionally the eyes.
Understanding Perioral Dermatitis
Perioral dermatitis is a skin rash characterized by red bumps, which can sometimes include scaling or pus-filled lesions, primarily affecting the skin around the mouth, nose, and chin. It may also spread to the eyes, in which case it is sometimes referred to as periorificial dermatitis. The rash can cause mild itching or a burning sensation. While the exact cause is often unknown, several factors are associated with its development.
Common triggers include the use of topical steroids, especially fluorinated ones, certain cosmetics, and fluoridated toothpaste. Other contributing factors can involve heavy moisturizers, certain sunscreens, and even hormonal changes. Perioral dermatitis is a distinct condition from acne or rosacea. Unlike acne, it does not typically involve blackheads or whiteheads (comedones). While it can resemble rosacea, rosacea is a chronic inflammatory condition with different underlying causes and typically affects the central face, but not usually directly around the mouth and eyes in the same way.
Azelaic Acid’s Role in Treatment
Azelaic acid helps manage perioral dermatitis through several scientific mechanisms. It possesses anti-inflammatory properties that reduce the redness and swelling characteristic of the condition. This anti-inflammatory action helps calm the irritated skin.
The acid also demonstrates antimicrobial effects, inhibiting the growth of certain skin bacteria and yeast that may contribute to flare-ups. This action helps to address potential microbial involvement in the skin condition.
Furthermore, azelaic acid aids in normalizing keratinization. By preventing the excessive buildup of skin cells and reducing the thickness of the stratum corneum, it helps keep pores clear and promotes healthier skin cell turnover. This keratolytic effect contributes to improving skin texture.
Applying Azelaic Acid and What to Expect
Azelaic acid is available in various topical formulations, including creams, gels, and foams. Common concentrations prescribed for skin conditions are often 15% or 20%. For application, a thin layer should generally be applied to clean skin once or twice daily, as directed by a healthcare professional.
When starting azelaic acid, individuals might experience mild side effects such as stinging, burning, itching, or dryness. These sensations are typically mild and transient, often diminishing with continued use. To manage potential irritation, it may be beneficial to start with less frequent application or apply it after a moisturizer for a short period before increasing frequency.
Improvement with azelaic acid typically takes several weeks to become noticeable, with significant results often seen after a few weeks to up to 12 weeks. It is generally considered safe for long-term use and may be an option during pregnancy, though medical consultation is always advised before starting any new treatment, especially during pregnancy. Some patients may experience a temporary worsening of symptoms in the initial days of treatment, particularly if discontinuing topical steroids.
Comprehensive Management for Perioral Dermatitis
While azelaic acid can be effective, managing perioral dermatitis often involves a broader approach. Identifying and avoiding triggers is a primary step in controlling the condition. This includes discontinuing the use of topical steroids, which are a common trigger, ideally under medical supervision to prevent potential rebound flares.
Switching to non-fluoridated toothpaste, using gentle skincare products, and avoiding harsh cleansers or heavy cosmetics can also be beneficial. Some individuals may find relief by minimizing sun exposure or being mindful of certain foods. In cases where symptoms persist or are more severe, a healthcare professional might consider other treatment options.
These can include other topical medications. Oral antibiotics may also be prescribed for more severe or persistent cases. Consulting a healthcare professional is important for an accurate diagnosis and a tailored treatment plan.