Original Article By Lexi Novak
The typical response to a breakout is swift and Pavlovian: See a bump, blast it with benzoyl peroxide or salicylic acid. So I did. But this time it wasn’t getting better. In fact, the inflamed blemishes around my mouth and chin seemed to get worse. And panic popping just made everything redder, splotchier, and bumpier (do not pop). Once desperation drove me to seek professional advice, I learned some surprising—and sort of sad—news.
First, those dots on my face weren’t caused by acne. “Hormonal blemishes usually involve the entire jawline,” says Beverly Hills dermatologist Harold Lancer. “Perioral dermatitis is totally different. It’s yeast bacteria usually [found] around the upper and lower lip area, the angles of the mouth, and maybe the nose. And it’s often presented as a reddish, orangey, waxy, lumpy, bumpy, inflamed pustule rash that comes in varying severity.” So basically the most appetizing-sounding thing ever.
That explained why the traditional acne treatments weren’t working. In fact, those types of inflammatory exfoliants can exacerbate perioral dermatitis. What did help was a prescription corticosteroid cream—at least for a while. “If you treat it purely with hydrocortisone, when it recurs, it gets progressively more difficult to control,” says Lancer. “It hides the symptoms, but it’s not treating the problem.”
And that problem is where my real woes began. Perioral dermatitis is triggered by an overgrowth of bacterial yeast, which can come from stress and humidity, two things I’m OK with never having in my life again. But it can also come from two things that make me unreasonably happy: carbs and alcohol. Lancer says sugar from bread, pasta, potatoes, rice, booze, and even fruit can all contribute. So lifestyle modification is the best way to prevent those bumps from resprouting. “We teach patients about nutrition—going to zero caffeine intake, zero dairy intake, and very low carb intake,” says Lancer, who completes the prescription with a topical blend of hydrocortisone and antifungal treatment, applied twice a day for two days.
I’m not a caffeine addict (I much prefer sleep to coffee), and I’ve never had a dairy-heavy diet (except for Friday pizza night, which is not negotiable). Cutting back on toast, penne, rice-with-everything, and cocktails has been the painful part. But I have seen a huge difference between the weeks I survive on Stromboli and the ones padded with veggies. Smooth skin is a pretty damn effective motivator.
What’s been most surprising, though, is how infrequently I use acne products now. What I always thought was acne was actually a lifestyle-triggered inflammation. By dialing back the constant smears of salicylic acid and benzoyl peroxide, my skin has also gotten softer and healthier. I still get the occasional, tiny whitehead because I don’t want to give up any food entirely. And that’s a tradeoff I’m 100 percent cool with.