I have been wanting to blog about Perioral Dermatitis (PoD) for aaages! It is one of the most common skin conditions that we treat and seems to be on the rise. It is often misdiagnosed (as acne or generalised skin sensitivity) and can be quite unpredictable with periods of flaring and remission. It is usually adult onset (more common in women) and can occur in combination with patches around the eyes (periorbital dermatitis) and in-between the eyebrows. It often seems to pop up out of the blue, which can be rather infuriating! There are a number of factors which leave the skin (and individual) susceptible to developing this condition.
In this Part-1 blog (because there is an awful LOT I have to say on the topic) I will share the key areas that leave you and your skin primed to develop PoD.
There is a lot of evidence that suggests that having a leaky, permeable skin barrier will actually increase the likelihood of developing dermatitis and food allergies. This is called the outside-in theory. A leaky skin is similar to a banana with no peel: pretty soon, that banana is going to lose its moisture, get dirty (bacteria and microbes) and start to lose its structural integrity. As Corneotherapists, we deal with this on a daily basis. Changes (or permeability) of the skin barrier lead to an imbalance in the immune system, reduction of protection (pH) and the ensuing inflammation will reduce filaggrin proteins (more on that later).
How do we get ‘leaky skin’?
Well, if you have ever used skin care with emulsifiers, makeup/sunscreen with chemicals and felt ‘tight’ then chances are you have leaky skin.
Irritants (like skin care & makeup with emulsifiers) cause the skin cells to break down prematurely. They also create a ‘wash out’ effect that draws essential fats out of the skin and increases water evaporation (transepidermal water loss – TEWL). As the skin barrier breaks down, the cracks allow allergens, such as dust mites and bacteria, to enter the skin. This contributes to flare-ups and can lead to infections and immune responses including allergic reactions and inflammation. Healthy skin has a pH of around 5.5. This acidic layer is known as the acid mantle. Research shows that dermatitis sufferers have skin that is not acidic enough, making the skin barrier defencless against microbes.
The acid mantle
- protects the skin from harmful microbes
- reduces the colonisation of pathogenic bacteria and fungus
- promotes beneficial bacteria
Not unlike acne, those with PoD also have altered sebum secretions, inflammation and oxidation in the follicle.
Issues with the barrier function and pH can be helped with Corneotherapy and Nutritional Supplementation.
Malassazia (fungal overgrowth)
PoD is thought to be caused by a fungal overgrowth of Malassazia. This fungus produces nasty by-products that cause irritation and inflammation in the skin. Malassazia flourishes when the pH of the skin is disturbed and is lipophilic (it eats fats and oils to grow and flourish). This is why PoD commonly flares with the misuse of skin care and oils as they will add fuel to the fire. Remember, our skin can only be colonized by a yeast if we have:
- leaky/compromised skin
- lowered immune function
- poor beneficial bacteria colonies
In my clinical experience, PoD is usually a sign of a dysbiotic gut. The gut and skin microbiomes have the ability to communicate and influence each other. I have found that 90% of clients showing PoD symptoms will also have an issue with a systemic candida overgrowth and/or parasitic infection. Those who have a history of antibiotic use are in the high risk category for a rebound candida overgrowth. Interestingly, a common trigger for PoD is the use of antibiotics (and yet they are so often prescribed for this condition).
We usually test gut function if we haven’t seen results with skin care, diet and supplements after around 4 weeks.
Fatty Acid Enzymes
A common issue with PoD is the impairment of an enzyme delta-6-desaturase. Essential fatty acids are the core building blocks for our cell membranes. Imbalances in EFAs are common with those suffering chronic inflammation (hello, all skin cases). Delta-6-desaturase is a key enzyme involved in fatty acid metabolism (specifically converting Linoleic Acid to Gamma-Linolenic Acid and Alpha-Linolenic Acid to Stearic Acid), whose function is affected by genetics and deficiencies in Zinc, Magnesium & B6. Insulin resistance also impairs this enzyme’s function. An imbalance of Omega 3 to Omega 6 can also heavily contribute to skin inflammation.
This is something that we also commonly test.
About 50% of people with Dermatitis will have a genetic issue with the Filaggrin gene. This gives rise to lowered production of the Filaggrin protein which disrupts the skin barrier (and contributes to leaky skin).
There is a rare type of dermatitis known as autoimmune progesterone dermatitis. More often, PoD can be aggravated by an imbalance in Oestrogen and Progesterone.
Allergies or sensitivities to gluten and dairy are common.
Stress is a big trigger for those with PoD. Stress will alter immune function, inflammation and the microbiome.
Stress and gut inflammation can impair the integrity of the skin’s barrier function.
Changes in weather can be big triggers. Humidity and heat can often exacerbate the condition, as well as sweat.