What causes perioral dermatitis?
The ‘barrel effect’ can explain this well.
We’re all born with an empty barrel. Throughout our life, we’re exposed to more and more chemicals, pollutants, bacteria, viruses, medications, allergens, and irritants that fill up our barrel. Once our barrel overflows, that’s when we start to see symptoms, like perioral dermatitis. When we were younger, our immune system was able to manage our symptoms, but it reaches a point where it needs our help and support.
Two things that may lead to the development of perioral dermatitis:
Hormonal Birth Control
Some of my clients have come to me because they have gone off of hormonal birth control, whether it’s the pill or the IUD, and suddenly find themselves with perioral dermatitis - something they’ve never had before. Let me explain the link between the two. Hormonal birth control contains synthetic steroids. Progestin, for example, is a synthetic steroid hormone that has progesterone-like properties; it prevents pregnancy by stopping a woman’s egg from fully developing each month. A side effect unbeknownst to most is the damage it can do to our gut microbiome. The gut microbiome is a community that consists of bacteria, viruses, protozoa, archaea, and fungi that lives in the gastrointestinal tract. This community keeps us healthy by protecting us from pathogens, aiding in digestion and nutrient generation, and educating our immune system to function properly. Unfortunately, the synthetic steroids in hormonal birth control can disrupt the balance of our gut microbiome and may affect its ability to regulate our immune response. This is especially apparent in perioral dermatitis where pro-inflammatory cytokines play a role in the state of our skin. Additionally, the gut microbiome can influence our hormones, which means that perioral dermatitis may be affected by both the state of our gut microbiome and hormonal imbalances.
Stress
It’s a vicious cycle that many with perioral dermatitis find themselves in - the stress from everyday life that causes pd in the first place and also feeling stressed by the rash itself. Not only can chronic stress cause perioral dermatitis, but it can also exacerbate pd as well. Chronic stress compromises the integrity of the intestinal lining and can cause leaky gut, where undigested proteins, bacteria, and micro-organisms can permeate the intestinal wall into the bloodstream. If you’re interested in learning the science behind leaky gut and how it can affect our skin, I’ve written another article that explores the stress-acne connection that you can read - it’s applicable to perioral dermatitis as well. In this case, the skin’s natural barrier function is compromised by chronic stress which prolongs wound healing. To speed up healing, it’s important to figure out your individual stressors and focus on ways to manage them. While exercise is one of the best ways to mitigate stress, one of my favourite tricks when I feel anxious is putting a hot water bottle on my abdomen. The weight of it helps ground those anxious emotions and the heat provides some relaxation. Give it a try!
References
M. J. Tetl, G. J. de Vries, R. C. Melcangi, G. Panzica, and S. M. O’Mahony, “Steroids, stress and the gut microbiome-brain axis”, J Neuroendocrinol., vol. 30, no. 4, PMID: 29024170. (Published online February 2018). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6314837/. (Accessed on March 14, 2021).
Hamed Khalili, “Risk of Inflammatory Bowel Disease with Oral Contraceptives and Menopausal Hormone Therapy: Current Evidence and Future Directions”, National Center for Biotechnology Information (NCBI) [Internet], vol. 39, no. 3, pp 193-197. PMID: 26658991. (Published online March 2016). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4752384/. (Accessed on March 14, 2021).