"After years of quietly dealing with perioral dermatitis (PD) I wanted to open up and share my journey." 

By Colleen Murphy
June 07, 2021
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Former Bachelor contestant Kristina Schulman is sharing a "raw, emotional, and unfiltered" look into her journey managing perioral dermatitis (PD)—a skin condition she has spent years "quietly dealing with."

Kristina-Schulman-Perioral-Dermatitis-GettyImages-891312484
Credit: Getty Images

On June 4, the 28-year-old posted a video to Instagram that showed pictures of her PD throughout the years. With selfies dating back to March 2019 and working up to present day, Schulman revealed what her face has looked like thanks to PD. This non-contagious skin disorder shows up as little red bumps on the lower half of the face, resembling acne or rosacea. The video includes images of "hopeful times," aka, when her skin was clear, as well as when her condition hit an "all-time low" in April 2021.

"This morning I woke up feeling down, overwhelmed, sad, and defeated. For the past few days I stayed quiet and off social media in hopes that I'll reach mental state where I can share my skins journey + progress — that progress hasn't come... just yet," Schulman began her caption. She then went into the details of her journey, getting honest about how hard it has been to see any progress and that she is "still struggling with random flare ups that hurt, itch, burn, feel very dry and tight," despite all her different attempts to manage her condition.

Fans and followers shared their appreciation for her public fight with PD. "Wishing you healing as I can imagine this is a frustrating journey and painful as well, I applaud you for your candor. I hope you find a solution soon and that you will have healing!," one person commented. "This is so so so beautiful. Thank you for being willing to share. So many women are feeling deeply connected because of you right now. So powerful 👏 this will only be the beginning of your healing," another said. "All I see is beauty❤️ you're so strong for sharing this! I can relate to how you feel so much," wrote a third user.

What does perioral dermatitis look and feel like?

PD typically affects the lower half of the face, typically the area around the mouth and the creases between the nose and mouth. Sometimes the rash spreads around the eyes, nose, or forehead, according to the US National Library of Medicine (USNLM), a division of the National Institutes of Health. PD usually appears red and slightly scaly or bumpy. The bumps around the mouth can be filled with fluid or pus. The rash may also itch or burn, but usually only mildly, per the American Osteopathic College of Dermatology (AOCD).

What causes perioral dermatitis?

There are a few triggers thought to bring on PD, according to the USNLM, including:

  • Topical steroids
  • Nasal steroids, steroid inhalers, and oral steroids
  • Cosmetic creams, make-ups, and sunscreens
  • Fluorinated toothpaste
  • Failing to wash the face
  • Hormonal changes or oral contraceptives

The AOCD cites prolonged use of topical steroid creams and oral/nasal inhaled prescription steroid sprays, as well as overuse of heavy face creams and moisturizers, as the most common causes.

How common is perioral dermatitis?

Schulman is certainly not alone in her PD journey. In fact, the condition is fairly common, Corey Georgesen, MD, assistant professor and director of dermatopathology at the University of Nebraska Medical Center, tells Health. "I see approximately 2-3 patients per week in my clinics with this condition, and it's very common in patients ages 15-50, and most commonly seen in females," he says. 

How is perioral dermatitis diagnosed?

PD is typically diagnosed via a dermatologist's examination. (A dermatologist first diagnosed Schulman with PD a couple years ago.) In some cases, your doctor might perform tests to determine whether the condition was caused by a bacterial infection.

How is perioral dermatitis treated?

Once a dermatologist diagnoses you with PD, they will probably tell you to stop using any steroid creams. "They may also prescribe a less potent steroid cream and then slowly withdraw it," the USNLM says.

"[PD] can be very difficult to manage because as you wean off the steroids, the rash can worsen and can persist for several months," Dr. Georgesen explains.

Your treatment plan may also include medications placed on the skin, like benzoyl peroxide, to help ease symptoms. In severe cases of PD, antibiotics might be prescribed.

On top of the medicine your doctor might prescribe, you might also be told to stop using all face creams, cosmetics, and sunscreen and to wash your face with warm water only, according to the USNLM.

How long does perioral dermatitis last?

Shawn Kwatra, MD, assistant professor of dermatology at Johns Hopkins Medicine, tells Health, "It can resolve in a few months or can last for many years."

In most cases, PD doesn't return after treatment, the USNLM reports. But even after successful treatment, PD can return—and that's what happened in Schulman's case.

The treatment plan Schulman and her doctor came up with worked for a couple months, but not in the long-term. That's when "doubt and defeat began to set in," Schulman wrote in her caption. It's also when she turned to lifestyle changes.

Can lifestyle changes help with perioral dermatitis symptoms?

Yes, there are a few modifications you can make to prevent or ease PD symptoms. "You can prevent perioral dermatitis by avoiding use of steroid creams and using gentle cleansers and moisturizers," Dr. Georgesen says.

And since fluoridated toothpaste may aggravate PD, staying away from this may help too, according to Dr. Kwatra. "Since many other substances can also irritate the skin, it is important to minimize skin care and cosmetic products that may be contributing to the perioral dermatitis," he says.

Eliminating makeup products that she sensed may have caused her flare-ups and using only a gentle cleanser and light moisturizer were some of the lifestyle changes Schulman made. "In late December of 2020 many of you have responded to my IG stories with your own personal struggles and what has helped you to either cope or treat the condition. I listened, researched, and took the advice that seemed fitting for me," she explained.

While none of her changes have helped yet, she hopes all the knowledge she has gained about her condition from others and online will help her be better prepared for her upcoming dermatology appointment.

"While I know I am not alone in this or with this condition (which is very tricky to treat since triggers are different for each individual) I hope we can create a community where we can openly share our journey and success stories," Schulman wrote. "…Thank you all for the love, the support, and advice that you've shared with me 🤍 going to keep you posted."

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