Spotty rashes on the face can look very alike, but how can you tell whether you’ve got perioral dermatitis or acne? We give the lowdown on both conditions.

Bumpy, inflamed, spotty and hot: your face is flaring-up but you don’t know why! Different skin conditions need different management strategies because they’re caused by different situations, and some treatments that soothe symptoms in one condition can worsen another, so it’s really important to know what’s what!

Perioral dermatitis is frequently confused with the more common acne, because they look and feel very similar, with pimples and inflammation on the face. So how can you tell them apart? Here are some clues!

WHO?

Let’s look first at the demographic most likely to suffer from either condition: acne tends to start in puberty in teenagers and young people of both sexes, and coincides with hormonal changes. It can last until people are about 30, and is very common; about 90% of people suffer from acne to some extent while they’re growing up.

Perioral dermatitis, on the other hand, usually affects young women past puberty, and has an age range of about 15-50, though mostly concentrated in the 20-40 range. It’s very rarely diagnosed in men and children.

WHERE?

Whereabouts on the body do the two conditions occur? Acne can manifest wherever the skin produces the natural oil (aka sebum) it uses to lubricate and strengthen its barrier function. This means as well as the oily area of the face, you can get acne on your chest, back, neck, shoulders and anywhere there are sebaceous glands.

Perioral dermatitis, by definition, occurs around the mouth. If the rash reaches up to the eyes or is focused around the nose, it’s known as periocular, periorificial or perinasal dermatitis instead. It can even affect the genitals, but it isn’t perioral dermatitis if it shows up on your chest or back.

WHAT?

So what does each condition look like? They may both be characterised by spots, but how do they differ, if at all? Acne is all about excess sebum blocking the follicles, causing bumps, inflammation and infection. It can manifest as various kinds of spots - whiteheads, blackheads, papules, pustules, nodules or cysts - some of which are pus-filled. Acne tends to start gradually and worsen, and isn’t usually itchy.

Perioral or periorificial dermatitis can come on very suddenly and feel - unlike acne - very itchy, hot and irritated. It looks like pimples, inflammation or bumps on affected areas of the face.

WHY?

Acne is usually seen as a hormonal condition, in which puberty affects the sebum production and causes excess oiliness in sebaceous glands. While acne can be aggravated by toiletries and diet, these are not root causes so much as contributing factors.

Hormones might also be involved in triggering flares of perioral dermatitis, as it can flare up for women going through pregnancy, in the premenstrual days of their cycle and when taking hormonal contraceptives. It’s often thought of as a kind of allergic reaction, triggered by cosmetics, sunscreen, paraffin-based creams, and other things put on the skin, hence one important way of managing perioral dermatitis being to avoid topical triggers.

Probably the most notorious trigger of perioral dermatitis is topical steroid cream; in that case, patients might see a continual cycle of improving and worsening dermatitis according to whether they’re using steroids or not.

In conclusion, diagnosis usually depends on who is suffering, what age and sex they are, where the rash occurs, and what might have triggered it, rather than simply whether or not there are spots present!

If you’re concerned about a rash on your face and don’t know what it is, get a diagnosis from your doctor; given that topical steroid creams are a known trigger for perioral dermatitis and are not recommended for acne, it’s important that you get the right treatment, so don’t just put eczema cream on your face!

For further information about what you can do holistically to manage flare-ups, see our blogs on How To Treat Perioral Dermatitis and Best Natural Treatment For Acne And Face Eczema.

Balmonds makes a great collection of gentle, natural skincare to keep sensitive skin healthy and clean, whether it is prone to acne, eczema or perioral dermatitis. None of our products contain soap, SLS, perfumes, paraffin or silicones, so they won’t strip oils from the skin or dry it out. Instead, the natural moisturisers and cleansers work in harmony with the skin’s natural oils, keeping it balanced and healthy.

Recommended products:

Balmonds Scalp Oil with tea tree, rosemary & borage (f14.99 for 50ml): a great natural antiseptic rescue oil for anywhere on the body, not just the scalp!

Balmonds Daily Moisturising Cream with hemp & shea (from £13.99 for 100ml): an unscented, paraffin-free nourishing cream for daily use.

Balmonds Rosehip Scar Oil with rosehip & calendula (£18.99 for 50ml): good for improving the appearance of acne scars and supporting the skin's cycle of regeneration adn repair.

Balmonds Natural Shampoo & Body Wash with nettle and chamomile (£19 for 200ml): an effective, unscented, SLS-free wash for body, face and scalp.

Balmonds Cooling Cream with menthol, aloe & lavender (£19 for 100ml): a calming lotion to take the heat out of itchy skin.