By Carita Rizzo
This is the era of a solution for every skin problem. Wrinkles? Reach for retinol. Melasma? Brighten your skin with niacimide. Generally feeling dull? Nothing a little ascorbic acid can’t fix. But these treatments can create another skin problem, one that’s particularly pernicious: dermatitis.
“I see it every day,” says Dr. Tyler Hollmig, professor and director of dermatologic surgery at Dell Medical School in Austin, Texas. “Skin sensitivity is more common now than it ever has been.”
According to the National Institute of Health, the prevalence of atopic dermatitis has increased two to three-fold in recent decades. Perioral dermatitis, which develops around your mouth, eyes, and nose, is also on the rise, according to a study by JAAD, with those ages 30-39 exhibiting the highest incidence.
There are multiple factors to blame, such as “physiological changes, including hormonal ones,” says Dr. Hollmig. “But then you have this other piece: Are we breaking down our own epidermal barrier by using too many skincare products?”
The question is, of course, rhetorical. “Skincare, in general, is powered by this enormous marketing industrial complex, so there’s a ton of snake oil out there that can be misleading,” he says. “You quickly get into this confusing alphabet soup of skincare. Certain things may be helpful, certain things may be a total waste of money, and certain things may actually be harmful to the skin, especially using multiple products, all of which have an irritating or exfoliating effect. That can really spin up a cycle of skin problems, particularly in sensitive skin.”
Daniela Ezratty, an Atlanta-based nurse practitioner who specializes in hormone replacement therapy, nutrition, and aesthetics at Ezratty Integrative Aesthetics, puts it even more bluntly. “People are prescribing their own skincare through TikTok,” she says. “They’re throwing an acid on, then moisturizer because they’ve burnt their skin. It’s often been in the fall that people who are very sensitive to [dermatitis] will get it, but now we’re seeing it even in young kids because of all the products.”
If you suddenly find yourself with persistent flaking, itching skin, or small red or pus-filled bumps – especially around the nose and mouth – hold off on products like topical steroids, which can be a contributing cause. A dermatologist can help you figure out what’s to blame. “Are you using a topical serum on your face? A minty toothpaste? Hydroxys? If so, let’s calm the skin down,” says Dr. Hollmig. “First, we’ll use a really bland moisturizer with as few ingredients as possible to reset. If you have a clear causative agent, let’s remove it, and then go really gently after that.”
Hollmig is not against using active ingredients to target skincare problems. “You can climb this therapeutic ladder, but you want to do it correctly,” he says. “It has to be a targeted approach.” That means using only one active at a time, at least to begin with. “Once a patient’s skin proves that it can handle that ingredient, then you can add in another active.”
In middle age, says Dr. Hollmig, “we lose estrogen and have a difficult time hanging on to water, so we have what’s called increased transepidermal water loss. We can’t retain moisture as well. We also lose production of certain fatty elements of the skin barrier over time – ceramides are the ones that are well known. The epidermis changes in a way that’s more prone to damage and drying. That’s part of this process that we see with dermatitis and perioral dermatitis.”
Which brings us back to use, and overuse, of products designed to irritate the skin. “Having a weaker wall makes us more prone to irritation,” he says. “If your epidermis can’t stand up as well to something that is stripping it or damaging it, you’re going to have more sensitivity and inflammation.” This is particularly tricky when using products intended to increase cell turnover. “A lot of the good things that we do in dermatology involve controlled damage. If you think about lasers or microneedling, those are microscopic injuries placed in a controlled fashion that lead to regeneration,” he says. “Skincare can be the same, but if you’re going into that battle with a weak, thin epidermal barrier, you’re more likely to get too much damage, too much inflammation, which looks like red, irritated skin.”
Perioral dermatitis is a tough adversary, and oftentimes product elimination is not enough. “A dermatologist can offer medical-grade treatment options such as safe anti-inflammatories, oral antibiotics, or other medications,” says Dr. Hollmig. Recurrence might require an oral antibiotic instead of a topical anti-inflammatory cream, or even a stronger medication like a systemic retinoid such as isotretinoin.
Mild cases of perioral dermatitis should improve within days to a week or two, with decreased irritation, scaling, peeling, redness, and irritated bumps, but more severe cases may not clear for several weeks. “Recurrence is a possibility but is usually caused by repeated introduction of a skin irritant,” he says (and FYI, many toothpastes can be triggers). “So, the goal is to remove the offender(s), treat the associated inflammation, give the skin some time to settle down and heal, and then educate the patient on likely exacerbating factors so they can avoid these in the future.”