I write a lot about perioral dermatitis (POD) on this site for a couple of reasons. First – I treat a lot of it in my Chinese medicine practice. Second – it’s a very rewarding condition to treat.
For people with skin problems, there’s nothing worse than a red and itchy rash that shows up right on the face. Patients with POD very often get great results with herbs. The physical changes are dramatic, but the emotional changes are sometimes even more significant. I’ve seen many cases where healing from POD is truly life changing.
For me, this is one of the conditions that really highlights why I’ve chosen to specialize in dermatology. It’s very rewarding when people can see major differences in their skin. But it’s maybe even more rewarding when they feel so much better in their skin (so to speak). Having clear skin on the face goes a long way in helping people regain confidence, happiness and overall well-being.
The Perioral Dermatitis Journey
It’s really common in my practice to see POD patients who have been on a frustrating journey of unrelenting skin flares. Often they’ve spent most of their lives with near perfect skin. They may have had mild acne in their teens, but sometimes not even that. Then suddenly – at the age of 25, 35 or 4, the skin develops this awful red rash. It can be itchy, it can be flaky, and sometimes there are bumps with fluid. Not knowing what to do, they’ll often try over the counter creams and ointments. Sometimes they help, and sometimes they don’t, but generally the rash gets progressively worse. Then they go to the dermatologist and are prescribed a cortisone cream that may or may not work. But as soon as they stop, the skin goes starts to totally flare – worse than anything they experienced before. They try to cover up the rash with makeup, and the makeup itself makes the skin worse. They’re bummed that they have this rash on their face, but even more bummed that *everything* they are doing to help is doing more harm than good. It’s truly crazy making! The skin changes from day to day, so they can’t tell what’s really causing changes, and the “healing” creams end up making it worse half the time.
So What Can I Put on My Face?
It’s been my experience that *anything* – even the most mild creams (including the herbal creams we make at our clinic) – can make POD worse.
My advice is to keep it simple. Whenever possible, don’t put anything at all on the lesions. Avoid makeup as much as you can.
If there is extreme dryness, flaking, or bad itching, then I recommend only using products that have one ingredient in them. Stick with single ingredient products and you’ll know how well your skin responds to that ingredient. Some of my favorites are:
- Vitamin E – very moisturizing for extremely dry patches of skin.
- Argan Oil – lightly moisturizing and anti-inflammatory. It doesn’t clog pores and can be used to moisturize the whole face and neck.
- Aloe Vera Gel – relieves itch. It won’t moisten the skin, but is very soothing. If you use aloe vera and one of the oils, don’t apply them at the same time. Use them each separately.
Each of these should be tested individually over a period of days to make sure there is no sensitivity.
What Causes Perioral Dermatitis?
People ask me this all the time. Chinese medicine looks at this condition as having two primary “archetypes” – the Liver archetype and the Spleen archetype. I’m capitalizing Liver and Spleen to distinguish them as Chinese medicine terms. In western medicine your Liver and Spleen can be 1% healthy, but Chinese medicine identifies them as whole meridian systems that have various imbalances.
The Liver archetype patient is prone to Liver Qi stagnation (one of the patterns of imbalance in Chinese medicine). These patients may be prone to irritability, stress, and frustration. They may have irregular or painful periods, or the skin can get worse around their periods. The rash on the face tends to have an angry red color and may itch.
The Spleen archetype patient is prone to Spleen Qi deficiency (another pattern of imbalance). These patients may have ongoing digestive problems such as indigestion, bloating, loose stools or gas. They may get tired easily or have a weak immune system. The rash on their face may be more pink or pale red with bumps with liquid or weeping.
These patterns are very commonly seen in Chinese medicine, and are the underlying root cause of POD. Very often a time of extreme stress may cause POD to develop in a Liver type patient. Eating unhealthy foods or ongoing digestive problems may cause POD to develop in a Spleen type patient. Often, people can have both these imbalances going on at the same time.
How do we Treat Perioral Dermatitis with Chinese Medicine?
As you know by now, my focus in healing POD is not to rely on topical products. My philosophy is all about healing from within. I prescribe custom herbal formulas that can have anywhere between 8 and 18 herbs in them. Each formula is individualized for the unique nature of the patient. We extract the herbs into a tea which patients drink twice a day. Every three weeks I change the ingredients in the formula according to the changing nature of the condition as it heals. A course of treatment generally lasts about 3 to 4 months, depending on the length and severity of the condition.
One Last Piece of Advice
If you are a female with POD and you are using birth control to stop your periods from coming every month, it’s highly possible that this could be contributing to your skin condition. Have I read any research studies to back up my claim? … No. But in my clinical practice I can tell you that I’ve seen countless cases of POD in women who stop their periods from coming each month. There is no other skin condition where I see such a direct link between not menstruating and developing an ongoing, recurring inflammatory rash.
From the perspective of Chinese medicine, this relates to the Liver Qi mentioned above. When the period is artificially stopped, the Liver Qi stagnates. Stagnant Liver Qi leads to heat which rises up to the face causing ongoing inflammation. Allowing your body to menstruate every month will allow the Liver Qi to course and flow as it should. This will go a long way in helping your body heal.
I hope this overview gives you a deeper understanding of Chinese medicine’s approach to understanding and treating perioral dermatitis. More info on our site can be found here: