Treatment for Dermatitis Around the Mouth
Topical corticosteroids are the first-line treatment for established dermatitis around the mouth, with emollients and soap substitutes used regularly to maintain skin barrier function. 1
First-Line Treatment Approach
Emollients and Barrier Protection
- Apply white soft paraffin ointment (petroleum jelly) to the lips immediately and reapply every 2 hours throughout the acute phase 2, 1
- Use emollients and soap substitutes regularly to maintain skin barrier function 1
- Avoid potential allergens in lip care products such as castor oil, benzophenone-3, gallate, wax, and colophony 1
Topical Corticosteroids
- For mild to moderate cases: Apply a low-potency topical corticosteroid such as hydrocortisone 1% cream twice daily for up to 2 weeks 3
- For more severe or persistent cases: Consider betamethasone sodium phosphate 0.5 mg dissolved in 10 mL of water as a 2-3 minute rinse-and-spit solution one to four times a day 2
- For localized lesions: Apply clobetasol propionate 0.05% ointment mixed in equal amounts with Orabase once daily during the acute phase 2
Second-Line Treatment Options
Topical Calcineurin Inhibitors
- Tacrolimus 0.1% ointment applied twice daily for up to 4 weeks 2, 1
- Pimecrolimus 1% cream applied twice daily, especially for steroid-induced cases 1, 4
- These are particularly useful for sensitive areas like the face where potent topical corticosteroids may cause skin atrophy 5, 3
Antimicrobial Options
- For cases with suspected bacterial involvement: Topical erythromycin 1.5% solution applied twice daily 6
- For suspected secondary infection: Take oral and lip swabs regularly and treat accordingly 2
- Consider antiseptic oral rinses such as 1.5% hydrogen peroxide mouthwash or 0.2% chlorhexidine digluconate mouthwash twice daily 2
Management of Pain and Discomfort
- Use a mucoprotectant mouthwash three times a day (e.g., Gelclair) 2
- Apply an anti-inflammatory oral rinse or spray containing benzydamine hydrochloride every 3 hours, particularly before eating 2
- Barrier preparations such as Gengigel mouth rinse or gel are helpful for pain control 2
Special Considerations
Potential Complications
- Overuse of topical corticosteroids can lead to skin atrophy, telangiectasia, and HPA axis suppression 1, 3
- Inadequate allergen identification can lead to treatment failure 1
- Premature discontinuation of treatment can lead to rebound dermatitis 1
When to Consider Referral
- Failure to respond to appropriate first-line treatment
- Recurrent episodes despite preventive measures
- Suspicion of allergic contact dermatitis requiring patch testing
- Uncertainty about diagnosis 1
Preventive Measures
- Maintain adequate hydration by drinking sufficient fluids 1
- Use products with UV protection when spending time outdoors 1
- Minimize exposure to irritants such as soaps and detergents 1, 7
- Apply moisturizer followed by cotton or loose plastic gloves at night for occlusion if hands are affected 1
By following this structured approach to treating dermatitis around the mouth, most patients should experience significant improvement in their symptoms and quality of life.