Stubborn Acne Around the Chin and Mouth

As an Esthetician specializing in Adult Acne and Sensitivity, acne in pores where oil glands are larger due to being located in the “T-Zone” but where pore sizes are smaller due to facial contours, is the most common problem I see in my clients, both in the salon and in my online adult acne coaching service across the nation.  Excess oil from all kinds of hormonal changes rush into pores causing inflammation of pore linings, resulting in swelling, redness and pain.

These areas of larger glands and smaller pores are located on the sides of the chin, around the mouth, the inner cheeks, and between the brows.  Sometimes, the sides of the chin will also extend to the inner jawline and lower cheeks.  

These are typically called “hormonal areas”, to which I have quite a few responses, but I feel the most important point to make is that all acne is technically hormonal.  The difference between one breakout and another for adults late 20s on up will depend on the level of oil production at any given time plus how much a pore is clogged by cosmetics or pulled tight by dehydration.  Painful breakouts in these areas are not necessarily indicative of a hormonal imbalance.  By the same token, “it’s just hormonal” sounds dismissive and unhelpful.

Calming inflammation with ice and either clay mask or salicylic acid as soon as these breakouts are seen or felt is the best way to get rid of breakouts aggravated by rushes of oil inside pores.  There are many things besides hormonal shifts that can trigger these kinds of breakouts; too much iodine in the diet, friction from hands, phone or pillow, pore clogging materials on hands or face from acne-aggravating skincare, makeup, hair care and hand/body lotions getting pushed into pores, to name a few.  When these are removed from one’s kitchen and bathroom and replaced by skin-friendly alternatives, acne clearing starts immediately.

And yet sometimes, it doesn’t.  Sometimes, it’s so stubborn, I really have to wonder if something else is going on.  Sometimes something entirely different, which doesn’t always look like acne, can look exactly like acne.

What else could it be??

One fairly common skin condition that can look exactly like acne is actually an acquired allergy/sensitivity, called Contact Dermatitis. 

On the hands it looks like dryness gone amok, most often caused by continual exposure to strong detergents in things like dishwashing liquid and shampoo.  These detergents can dissolve so much of the skin’s protective components, water can escape from “broken” sections of the skin in a process called Trans-epidermal Water Loss, or TEWL.  In addition to the extreme dryness this causes, blood vessels and nerves are now closer to the surface in these areas, leading to extra sensitivity, redness, and itching or burning. 

Certain topical drugs are also known to cause Contact Dermatitis, like Neomycin and Hydrocortisone, and even a few natural substances can, like Lavender and Jojoba.  One very popular lip balm has been found to cause Contact Dermatitis in many people. 

So what about the chin and around the mouth?  The usual suspect is the foaming agent in most toothpastes.  Some people can also acquire a sensitivity to either the mint or cinnamon, or both, that are also in most toothpastes as well. 

If you brush your teeth after (or without, yeah I’m looking at you) washing your face and then rinse with a cup, after which you wipe away leftover foam with a towel, and if you don’t rinse your mouth like crazy and tend to drool even just a little at night, the residue left over after wiping, or the little foam that makes it’s way down your skin with your drool at light, can irritate your pores so horribly over time, you can end up with an ongoing breakout that never seems to go away no matter what you do.  This is Contact Dermatitis. 

When I see breakouts on the sides of the chin that are close to the lower lip, especially when they’re located more on one side than the other, and if there is angry redness surrounding these acne-looking blemishes, or if they’re located directly underneath the lip with the outsides of the breakouts going in a downturned pattern, I first ask how long the breakouts have been around, and if they’ve always been in this particular pattern.  If the answer is long time and yes, then I ask about the client’s brushing routine.

No acne medicine or skincare treatment is going to touch this.  The offender has to be taken away, plain and simple.  The treatment is to always brush your teeth before washing your face, rinse extremely well inside your mouth and outside, and cut out all peppermint and cinnamon from your diet until the problem clears.  More importantly, you must switch your toothpaste to one that has none of the foaming agents that cause this problem.  A good choice is Sensodyne Pronamel.  What to look for and avoid :  Sodium Lauryl Sulfate and Sodium Laureth Sulfate.

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“I’ve got this breakout around my mouth and my nostrils.  It never seems to go away, nothing ever works, it’s really irritated, dry and flakey, and it sometimes itches.  I’ve used drugstore acne meds, coconut oil, all kinds of cleansers and nothing.  A while back I even tried Cortaid, cleared it up a little bit, but then a week later it was the worst it’s ever been.  I tried extracting the little pimples there, some are little white heads, some are just hard red bumps, but most of them don’t come out at all.  They just keep persisting.  Help!”  -Meghan P.

After reviewing all of her products, allergies and photos sent with her Eval by Email® form, I was sure this was something called 

“Perioral Dermatitis”.

Perioral Dermatitis in actuality looks more like a rash than acne.  But when the wrong remedies are used (especially coconut oil, which is highly comedogenic), it can flare up in such a way that it can look more like a collection of small acne blemishes.  Hence the mistaken identity.  Aside from its rash-like appearance, stopping about a ¼ inch away from the entire lip line is another telltale sign (although this does not always happen).  Within the rash are tiny pimples with and without white heads, occurring mostly in clusters.

It can affect men, but most often it occurs in women.  

 It can be caused by several different assaults, such as the skin’s barrier being compromised by harsh products resulting in a change in the skin’s natural flora, overuse of steroidal medications such as nasal sprays and eczema creams, surface bacterial infections, and immune system issues.  Interestingly, it has not been found to be connected to yeast. 

The most frustrating thing about Perioral Dermatitis is that can be quite difficult to get rid of.  Using Mandelic Acid in my facials and low dose every-other-day application of Benzoyl Peroxide has worked in some cases, but aside from making sure skincare is hydrating, calming and 100% non-comedogenic, topical prescription antibiotic together with a strong topical anti-inflammatory is really the best way to go.  Two that make the most sense to me are Clindamycin and Azelaic Acid (Finacea).  In super severe cases, 6-12 weeks of oral Doxycycline is recommended.   Metronidazole works in some cases, as well.

Your doctor may tell you to not wash your face with anything but water and stop using all sunscreens, but too many of us have seen negative consequences from doing that.  I suspect the reason for telling patients this, is an assumption that all cleansers are harsh and all sunscreens are made with film-forming mineral oil, both of which can very much worsen the problem.  On the other hand, sometimes it’s a matter of eliminating possibilities when it comes to looking for causal factors.  Usually, though, a gentle gel cleanser, hydrating, non-clogging sunscreens and repairing, hydrating moisturizer, all as **non-natural** as possible in order to give the skin as little as possible to react to, seems to work best with topical Rx medications for this skin disorder.  In this case, as well, a switch in toothpastes and avoidance of mint and cinnamon is helpful.   As with Contact Dermatitis and hormonal breakouts, stopping all lip balms containing petrolatum and petroleum jelly, and avoiding all pore-clogging skincare and cosmetics will help the skin heal much faster.

It’s very important to note that in cases where a Perioral Dermatitis is caused by steroidal meds like hydrocortisone or other topicals for eczema, the condition will get worse before it gets better, as the skin gets used to the cessation of these steroidal meds.

Hopefully this clears things up for you (ha!), and that you’ve gained some insight into the chin and mouth breakouts that plague you.  If you have any specific questions about your breakouts, please contact me!

Your acne problem has a source, and clearing your skin requires finding that source and either eliminating it or healing it.  You can start that right now by filling out my Eval by Email® Online Skincare Consultation Form created specially for ages Gen-X to Baby Boom!

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