Facial Eczema with Dr Lynn Chiam: Rashes around the Mouth and Lips

Dr Lynn Chiam, a consultant dermatologist who subspecializes in paediatric skin conditions

This is a series focused on facial eczema, with the privilege of having Dr Lynn Chiam, of of Children & Adult Skin Hair Laser Clinic, to help explain further the type of facial rashes, its treatment options and daily facial care. Dr Lynn is a consultant dermatologist who subspecializes in paediatric skin conditions at Mount Elizabeth Novena Specialist Medical Centre, Singapore. Apart from paediatric dermatology, her other subspecialty interests include adult pigmentary conditions and laser dermatology. More on Dr Lynn can be found here.

Why is the area around my mouth and my lips red and itchy?

This week’s focus is on another prominent part of the face – the mouth and the lips. Apart from being prominent and noticeable as one will look inevitably look at someone’s mouth when he/she is talking, the lips is also an area that comes into contact with the food we eat, lip balm, lip stick and to some extent, toothpaste! This post will be in the form of Q&A, kindly assisted by Dr Lynn.

Question 1 – Clarifying the type of rash: What sort of rash is common around the mouth? And is the same common on the lips? What is allergic contact cheilitis?

Dr Lynn: Some of the common rashes which can occur around the mouth include

  1. Facial eczema. This happens in individuals with eczema and facial eczema is more common in infants.
  2. Perioral dermatitis consists of groups of itchy or tender small red papules (bumps) which appear most often around the mouth. They spare the skin bordering the lips but develop on the sides of the chin, then spreading to include upper lip and cheeks. The surrounding skin may be pink, and the skin surface often becomes dry and flaky. Perioral dermatitis can be caused by the overuse of steroid creams, moisturizers, make-up and sunscreen. It is important to see your doctor as a course of oral antibiotics is needed.
  3. Cheilitis is inflammation of the lips. It can cause deeps cracks at the sides of the lips which can be painful. There are many causes of cheilitis and they include: eczematous cheilitis, contact cheilitis (reaction to substances like make-up etc), medications and nutritional deficiencies. Allergic contact cheilitis is allergic contact dermatitis affecting the lips. It is an immune reaction of the body towards a substance to which the individual is allergic. Lip cosmetics, toothpaste, medication and dental materials are the most common cause of allergic contact cheilitis.

Question 2 – Identifying the Allergen/ Irritant: What can one try to isolate the product or food that is causing the rashes? For instance, should one note if a rash occurs after shaving, brushing teeth or ingesting certain food? What is the appropriate allergy testing?

Dr Lynn: The appropriate test is the patch test. A patch test is a method used to determine if a substance is responsible for causing an allergic inflammation of the skin. Diluted amounts of the substances are placed in contact with the skin on the back. If the individual is truly allergic to the substance, a local reaction will occur on the skin. Testing should include the standard series of test allergens as well as any other materials suggested by the history (like lip cosmetics, toothpaste). If you notice that a particular facial or dental product or food causes a rash around the lips consistently, do inform your doctor and include it into the patch test.

Question 3 – Food versus Contact Allergens: Is there a difference in the time lag between an allergic reaction triggered by contact, say with a musical instrument, or a cosmetic/skincare product versus food?

Dr Lynn: Allergic contact dermatitis triggered by contact with a musical instrument or cosmetic/skincare product is an itchy skin condition caused by an allergic reaction to a substance in the product. It arises some hours after contact with the responsible material, and settles down over some days provided the skin is no longer in contact with the skin. Contact dermatitis should be distinguished from contact urticaria, in which hives appears within minutes of exposure and fades away within minutes to hours.

Likewise, food allergy can present with immediate reactions occurring within minutes after ingestion like swelling of the lips, hives and in more severe cases, difficulty breathing. It can also present few hours later and can cause late reaction like eczematous rash.

Question 4 – Treatment: What is the treatment available for lips? Can steroid be applied?

Dr Lynn: If the lips are involved in contact dermatitis or eczema, a low potency steroid or a topical calcineurin-inhibitor like Pimecrolimus or Tacrolimus can be applied. As the skin on the lips is thinner and absorbs more cream compared to similar sized-skin on other areas on the body, only low potency steroid creams should be used for a limited amount of time.

Thanks Dr Lynn for helping us learn lots about facial eczema this month!

For previous posts in this series, see

Facial Skin Rash – What Rashes on Face (part 1 and part 2)

Facial Skin Rash – Rosacea and Psoriasis

What Treatment to put on Face

Rashes on Eyelids

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41 thoughts on “Facial Eczema with Dr Lynn Chiam: Rashes around the Mouth and Lips

  1. Pingback: SOMEONE has Eczema and managed Make-up | Eczema Blues

  2. How do you cure the redness around my lips? Irs red and its obviously noticable it has bumps around it, it can be itchy and skin may come off. Help its very irritating.

    • Sorry to hear that.. it can be more than one type of skin condition at the lips so can’t really say how to get rid of the redness without seeking the help of a dermatologist. Have you seen one yet? In the meantime, keep cosmetics products off.. hugs.
      Take care,

  3. I’ve got red blotches either side of my lips, it can itch really bad some times, but I can’t seem to get rid of it. It didn’t bother me that much until I noticed that the redness was beginning to grow and get more noticeable.

    I’ve got the same stuff on my hands and all up my arms as well. My GP prescribed an emollient moisturizer cream and something called Eumovate? It doesn’t seem to be working, though. :(

    • Hi Anastasia,

      Hope your skin has got better in 2014! Eumovate is a low potency steroid cream. May want to take an allergy test. Also, did you have eczema/allergy when young? Usually if it’s eczema, it will have started as a child. If not, could be other form of dermatitis, e.g. contact with irritants.

      Take care, hugs,

      • Had it when I was a kid, but it only returned recently. They’ve given me a more powerful steroid now, so here’s hoping it’ll help!

        Happy new year, by the way. :)

  4. I have had this rash in just the corners of my mouth, nowhere else, for the last couple of months, and I can’t figure out what it is. I’ve never had eczema before, and there are no blisters or cracking of the corners of the lips, or bleeding. It just started off with redness and a little scaliness. Now it is starting to itch and become annoying but no tenderness or pain. I tried tea tree oil with vitamin E, but that didn’t help, and some homemade salve, which didn’t help much. It gets a little better, then flares up again. I’m almost fifty and I’ve never had this before, so I’m baffled! Any thoughts?

    • Hi Romy,
      I’ve no experience with this too, but offhand, I can think of cutting out the facial products you’re using (may take some time for the skin to be hypersensitive to it, i.e. not this morning you use, and afternoon you see a rash), moisturizing (oil is not a very good moisturizer, choose a fragrance and preservatives free one) and observe. If it still rashes, got to see a dermatologist. Be careful that if you’re seeing a GP, you’d likely get a higher potency cream (cos they don’t carry low potency one) which isn’t really suitable for thinner parts of skin like the face.
      Take care!

      • Thank you! I switched toothpastes almost a month ago, to Tom’s of Maine, and all I use on my face is coconut oil, and the same make-up I always have. This is very odd, and I’m baffled! I have contacted my naturopath, to see if she can treat it, or recommend a good dermatologist.

          • Hi I had this for about 6 months and the corners of my mouth would crack and be so sore. I discovered it was because I was eating cornchips often and it just have been when the chips rubbed against the corners of my mourh when I was eating them.aybe something your eating is doing the same?

          • Thanks for sharing this! Interesting, so the rash/dryness stopped after cornchips? I wonder why though? Cos of the texture/abrasion, the inflammatory nature of processed foods or some hypersensitivity to corn? Thanks for sharing this, collectively we can figure out about rash around mouth – many struggle with it! All the best in the new year too!

    • Hello Romy, I’m a 40 year old mother that has that same rash around the corners of my mouth. My post in a few posts below yours. When a flare up starts do you ever get little kinda like white heads on the top of your rash? My rash appears after eating anything with tomatoes, potatoes and chocolates with nuts. Within minutes red itchy,swollen painful rash, with some of the red spots having white heads on top. This rash comes and goes but just when it’s starting to heal it flares up again. Very frustrating to say the least.


      • Mine isn’t so much like whiteheads, just more like little pieces of dead skin flaking off. Then it itches and gets red underneath. My naturopath suggests that it may be a vitamin deficiency, particular of B, due to something I’m eating that may be irritating my gut and blocking it. I quit using Xylitol, a sweetener, as the timing seemed to match when I started using it. It has improved some, but not quite gone away. It flares up here and there. It seemed to do better when I remember to take vitamin B, so I’m going to keep trying that as well. Yeah, it IS frustrating! And even makeup doesn’t cover it all that well.

      • I have the exact same thing with the white heads. Ive been using silver gel which keeps it from getting really bad but I have to basically scrub it and then put silver on. Very weird. Still havent figured out what it is

    • I just asked someone at a Natural Food Store about redness and scaliness at the corners of mouth and she said she had the same thing. It was when she had a mold problem in her master bath.
      I have had this for the past month and just found mold in our bathroom. She thinks she took anti fungal supplements and she
      did get better. I have been eating more chocolate recently, so I
      am going to cut out sugar and chocolate, along with removing mold off shower walls. (already GF and Dairy free, except for
      recent milk chocolate)

      • Thanks for sharing Nan! Mold is one of the common indoor allergens and you can test if you’re allergic to it via skin prick test. Definitely cut down on inflammatory foods :) Good for general health too!

  5. I need help please .rashes comes on my lips turns to blisters then dry up and peel.repeadly since february.now the rash is coming out round the mouth. What do i do?

    • Sorry to hear that Ruth! Did putting moisturizer and avoiding facial/wash products help? Any chance to see a specialist and take a patch test?

  6. Hello, I’m a 40 year old women that has always had sensitive skin so I don’t use make up or any soaps on my skin. I wash with warm water and that’s it. No perfume or scented lotions either. I’ve always had perfect skin except for a few years ago I started having red, swollen, itchy spots around the sides of my mouth. With trial and error I figured out my rash always appeared after eating tomatoes, ketchup, or tomatoe sauce etc. Recently I’ve noticed it appears after eating potatoe chips or chocolate bars with nuts. I’ve been diagnosed by doctors that have said….. Cole sores, acne and today rosesatia. It’s very frustrating that no doctors will listen to me and my symtoms. I know this is some type of strange developing allergy. Why else would it appear seconds after I eat tomatoes, chocolates, or potatoe chips. They have prescribed steroid creams which control it but never clear it up completely…..I’ve sort of started to give up and just seem to avoid public situations which isn’t easy because I have 4 children.

  7. Thanks for this article. I have an redness, itchiness, flaky skin on my lips and around my mouth for the last 2 years. No matter what I try, I can’t get it under control. I use only vaseline on my mouth because anything else irritates it more. Vaseline keeps it from drying and cracking, but the redness and itching won’t go away. I’ve seen a dermatologist more times than I can count. I’ve changed facial products, toothpastes, done the allergy patch test, done the food sensitivity test, eliminating all those items on a trial basis but still have the problem. Any advice is welcome…I’m clearly at my breaking point by now!

    • Sorry to hear of this JG! Maybe can check with your dermatologist on Protopic – its non-steroidal for thinner skin and I read some forum users saying it worked for them (but there are also others that say didn’t work). Do ask your doc about it, take care!

  8. I have had a “mustache rash” above my lip for 2 years now. Dermatologist say it’s eczema, which I have had all my life, but this is different. The patch of skin between my nose and top lip stays inflamed red, dry, flaky, and at times may itch a little and flares up worst when my allergies are triggered or I eat something like fruits, veggies, ect. I am at my wits end! Nothing helps…I’ve tried creams, natural creams, no makeup or lotions on it for months….any idea what could the trigger be or what I should do? It’s so embarrassing it looks like a red mustache every day of my life not to mention I have angular chelitis, asthma, allergies, and alot of steroids in my 28 years. HEEEELP

    • Sorry to hear that Jessica, hugs! Any chance of allergy test/ patch test giving you any idea? I’m not sure if it’s anything to do with sweat.. I read that sweat in crystal form can irritate skin and wiping off it will help. If I have a hint of what it might be, I’d let you know. Off the top of my head, I’m wild guessing it could be sweat and hoping that patch test can help figure it out.


  9. Im 16, and i have had this for about 2 years now, its on my upper lip, its all red and getsvreally itchy and dry and oftsn look like I have a mustache. I also have red/brown like skin around the dorners of my mouth which also tend to get very itchy and dry and skin peels off at times from there.I have tried so many creams such as betnovate, diprobase, doublebasd gel and also mny emoilents and even vaseline, but nothing seems to work and its so irratating and embarrasing as its so noticeable, please I really need your help

    • Hugs Jessica! I understand the rashes around the mouth is so apparent that it would affect how people look at you, hugs and hang on. Have you seen a dermatologist? I’m thinking whether you’ve tried topical calcineurin inhibitor creams that are non-steroid? Also patch testing? Allergy to ingredients we use can develop overtime, so it may even be something which you’ve been using. The other thing I could think of is sweat residue.
      Check out this post by dermatologist Dr Cheryl Lee where she mentioned about sweat residue in sold form irritating the skin.

      Take care,

  10. It looks like I’m in good company here! I had allergy testing done today because I truly think that when I eat certain things–tomatoes, bell peppers, bananas, coffee, sometimes tree nuts–my problem gets worse. However, skin tests today ruled out all those (except they didn’t test coffee). I am so embarrassed at this yuck around my mouth. It looks like a bad clown-paint job, not to mention it’s incredibly itchy. It feels like a burn. The allergy doc said they could try skin patch testing, but I don’t know if I want to do that yet.

    I found another website that recommended stopping all heavy face products, even natural ones like beeswax. I stopped regular toothpaste a couple months ago, thinking it might be the foaming agent, and have been using children’s toothpaste. But here, I read that maybe it’s fluoride in the toothpaste.

    So, thank you all here for the excellent ideas for me to try. I’m going to stop using lotion on my face, no more beeswax lip balm, wash with water only for awhile.

    I wish all of you the best in your quest to solve your problem!

    • Hi Shawnna! Good that you dropped by and share with us your experience! Do go for the patch testing – you’d know which ingredients irritate your skin and thereafter, you can start scrutinizing all products you use and make sure those are excluded! If you’re in the US, I think you can get the dermatologist to enter these ingredients into the ‘CARD’ database which would then give you products with/without those ingredients. That would make life easier :)

      Take care and keep us updated!

      • My rash has healed significantly! I went ahead and used the steroid ointment the allergist prescribed after a few days of trying to let it heal on its own and not getting noticeable improvement. There is a bit of red left, which is understandable given the nasty rash that was there. I’m convinced it’s beeswax! I’ve even eaten some bananas and tomatoes recently and not had a reaction! I feel like I’ve been healed just by knowing what to stay away from I’m going to go ahead with allergy patch testing next week, but just learning on my own that beeswax may have been my problem for years is amazing. It certainly explains why I haven’t been able to wear makeup for about 20 years now.

        • This is such great news Shawna! Yes, definitely supportive of allergy test – there are so many chemicals/ingredients in a product and some of it we may not notice or be able to identify easily. It’d even be better if your doctor has access to a database or can advise which products to use that won’t contain those ingredients you’re allergic to!

  11. Hi, I’m 15 years old and I’ve been having problems with my lips for about 5 months. I’ve tried blistex balm and a steroid cream called cutivate and I’ve tried applying honey on my lips to. But nothing has helped. I have redness on my upper lip and even below my lips. and my skin also peels in those areas and can become very irritating. I apply vaseline before going to sleep. I dont think I am allergic to anything and i don’t apply makeup. I was wondering what to do and just wanted to ask in case you would be able to tell what this is being cause by.

    • Hi, sorry to hear of your problems – visit to dermatologist hasn’t helped? I’m thinking asking about topical calcineurin inhibitor cos the lips being very thin, may want to explore non-steroid option
      Triggers? allergy testing? Sweat residue?
      If the steroid cream doesn’t work, you may want to consider getting an earlier appointment with your doctor and asking for an alternative cream. It shouldn’t have not worked for months, typically results should be seen in a week with steroid cream.

      Take care and keep us posted,

  12. Hey guys
    I have eczema all over my body really bad! But at the minute I keep getting a red itchy patch just in the middle of the top of my lip….. It gets dry and really flakey? just wondering if anybody could help ??

    • Hi Jack, thanks for dropping by. I’m not sure.. is it from sweat residue? Not sure about dry and flakery though.. no help from doc at all?
      Take care,

  13. Hello my name is Jeremy and I have this rash on my face, cracks on my lips, and swollen eyes. This is the second time this has happened but the first time my face didn’t swell up. I went to the doctor the first time and they said it was caused by me eating a pineapple. I haven’t ate pineapple since then but recently I ate a mango and it came back. The first time lasted for about a week and it has been 3 days since I ate the mango. The rash is red and scaly. The cracks on my lips go deep and the dead skin peels off and when I wake up in the morning my face is usually swollen. The swelling usually goes down after I take a benadryl. Both times this has happened I had a canker sore in my mouth. Can you please tell me how to get rid of it or how to prevent it?

    • Sorry to hear of your rash and swelling. Did the doctor do any test before concluding it is pineapple. Read that mango peel/parts near the skin tend to create more allergic reaction than the flesh inside. I think taking an allergy test is worth considering, esp when there’s swelling since swelling around the throat area is dangerous. In the meantime, may want to avoid fruits in similar group with pineapple and mangoes like kiwis, peaches, papaya, avocado and bananas. Also avoid contact with latex as this material is cross-reactive with these tropical fruits’ allergy. Best thing is to get allergy tested, that way, you only avoid fruits that you’re allergic to. Check out oral allergy syndrome too – there are various pollen that may trigger allergy for those with certain allergies to fruits.
      Take care, do get tested too as there are cases of anaphylactic shock in adults with these allergies,

  14. hi there! I amm 23 years old and work in the medical field, it Is extremely embarrassing when I walk into work with a red rash around my mouth, either its flaky and itchy or swollen and red and I just look awful. I don’t use anything other than Vaseline jelly and oatmeal soap on my face. I recently found out I became allergic to soy based items (soap, food, etc) I don’t have insurance either so I cant go get a food test done right away. any recommendations?

    • Sorry to hear that Destiny :( usually either mild steroid (in Singapore, we can get it from pharmacy in hospital without seeing a doc) or Protopic (requires prescription). Maybe not use vaseline? See this post for more info – paraffin may irritate skin for some.. but creams without paraffin tend to be more expensive as the replacement ingredients to lock in moisture (likely) cost more.

      If the eczema is just on your face.. may not be food related.. could be contact eczema. Consider patch test to have more clarity on the irritants?

      Take care, big hugs,

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