Problem: I can't seem to get rid of these red, swollen, sometimes crusty bumps around my lips and at the sides of my nose. Nothing seems to help, including over-the-counter acne products and cortisone creams. What can I do?

Solutions: What you describe sounds like an almost classic case of perioral dermatitis. According to the American Academy of Dermatology (http://www.aad.org) "Perioral dermatitis [POD] is a common skin problem that mostly affects young women [20 to 45 years of age]. Occasionally men or children are affected. Perioral refers to the area around the mouth, and dermatitis indicates redness of the skin. In addition to redness, there are usually small red bumps or even pus bumps and mild peeling. The disease can look a lot like acne. The areas most affected are the areas from the nose to the sides of the lips, and the chin... . Sometimes there is mild itching and/or burning."

POD is actually quite common and, according to most dermatologists, is increasing in incidence (Source: Australasian Journal of Dermatology, February 2000, pages 34–38). While little is known about what causes this disorder, there are theories that overuse of topical cortisone creams, fluoridated toothpaste, or heavy or occlusive skin-care ointments and creams (especially those with a petrolatum or thick wax base) and foundations may be responsible. Exposure to sunlight, heat, and wind can also make matters worse (Source: eMedicine Journal, August 1, 2001, volume 2, number 8).

You can experiment by stopping the use of any of the potentially problematic products mentioned above. You should also discontinue the use of topical cortisone creams, but be aware that this can initially make matters worse. That can feel self-defeating, but be patient for a few weeks to see if the condition improves.

It would also be helpful to find out if fluoridated toothpaste is the source of the problem. You can try brushing with fluoride-free toothpaste such as Tom's of Maine Natural Fluoride-Free Toothpaste and see if that makes a significant difference. If fluoride-free toothpaste turns out to be the solution, check with your dentist to see how this will affect your dental health.

If these experiments lead you to suspect POD is indeed the cause of the bumps around your mouth and nose, it is best to see a dermatologist because there are no cosmetics or over-the-counter medications that can treat the condition. A dermatologist can prescribe topical metronidazole (MetroGel, MetroLotion, or MetroCream), alone or in combination with either oral tetracycline or erythromycin. Even though topical cortisone creams may be the cause of POD, you may be prescribed a low-potency cortisone cream to reduce the inflammation and to help you wean off the stronger topical cortisone cream you may have been using (Source: Seminars in Cutaneous Medical Surgery, September 1999, pages 206–209). For more information on POD, visit http://www.aad.org/pamphlets/Perioral.html (this URL is case-sensitive).

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