Ah, slugging season is here. As the weather gets colder and drier and our skin needs serious hydration, skin slugging has become the go-to method to relieve dry skin during the fall and winter months.
Skin slugging is a technique that involves applying a thin layer of an occlusive product, such as a petroleum-based healing ointment or jelly (e.g., Cerave Healing Ointment or Vaseline), to the entire face like a mask locking in moisture.
Slugging might seem the perfect fix for much-needed relief for dry, irritated skin. Although many dermatologists approve of skin slugging for normal skin, they warn that this technique may worsen certain skin conditions.
“In general, anyone who is predisposed to acne, rosacea, sensitive skin or perioral dermatitis should be cautious with slugging,” said Dr. Angela Casey, an Ohio-based board-certified dermatologist.
Perioral dermatitis is particularly tricky because the occlusive environment created by skin slugging can trigger and exacerbate this difficult-to-treat rash.
What is perioral dermatitis, and what causes it?
According to the American Academy of Dermatology, perioral dermatitis is a skin rash that can manifest as “small, red, acne-like breakouts,” patches of dry, flaky skin, and areas of red, inflamed skin with an itching or burning sensation. It’s a common skin care condition.
Unfortunately, narrowing down how to treat perioral dermatitis can be challenging, as this skin condition has many potential causes and triggers, which is why it’s always important to consult your dermatologist.
Sensitive skin can be a predisposition
“Individuals who have rosacea or sensitive skin may be more predisposed to developing perioral dermatitis,” Casey shared.
However, those with “normal skin” are not in the clear as certain products can create irritation that triggers perioral dermatitis.
“Using many different skin care products (e.g., using retinols plus AHAs plus antioxidants plus peptides) can break down the skin barrier, predisposing the skin to perioral dermatitis,” Casey said. “Fluorinated toothpastes and mouthwashes have also been linked to perioral dermatitis.”
Occlusive environments aren’t good for PD
While the occlusive nature of thick moisturisers, petroleum jelly or oils can work wonders on dry skin by trapping moisture and preventing water loss, this type of environment can make perioral dermatitis worse.
“Creating an occlusive state can exacerbate inflammation in the skin,” Casey said.
And it’s not just skin care products that can create an occlusive environment. While face masks protect the user from many airborne illnesses like COVID-19, they can also create an occlusive environment that can trigger perioral dermatitis.
“Wearing a face mask, such as in a healthcare setting or during the recent pandemic, can trap moisture and cause irritation to the covered area. This can result in a flare-up of perioral dermatitis,” Casey said.
Steroid-based topical skin care products can trigger PD
While many use topical corticosteroids, like hydrocortisone creams, to treat skin rashes, these creams can trigger perioral dermatitis.
“To a non-dermatologist, perioral dermatitis sounds like a rash that they can put cortisone cream on,” said Dr. Elaine Kung, a New York-based board-certified dermatologist, assistant professor of Dermatology at New York Presbyterian - Weill Cornell Hospital, and founder of Future Bright Dermatology.
Additionally, other types of steroids can also trigger perioral dermatitis.
“Individuals with asthma that require a steroid inhaler are also more at risk for perioral dermatitis as the steroid molecules can land on the skin around the mouth during inhalation,” said Casey.
Inflammation will make it worse
As perioral dermatitis is an inflammatory skin condition, it can be triggered and worsened by factors that cause inflammation.
“Lack of sleep creates stress throughout the body, including the skin, and this can contribute to perioral dermatitis,” Casey said. “A diet with lots of processed foods and/or foods with high glycemic indexes can also cause inflammation in the skin.”
How do I treat perioral dermatitis?
With a long list of potential causes and triggers, perioral dermatitis may require trial and error to narrow what is causing the rash.
“I recommend that patients eliminate as many potential offending agents as possible so that we start with a clean slate,” Casey said. “Try changing your skin care, mouthwash, and/or toothpaste and see if this improves symptoms.”
As one of the many causes of perioral dermatitis includes disruption to the skin barrier, replacing skin care products with gentler alternatives can be helpful.
“Any cleanser or soap that is too harsh or drying to the skin will only irritate the skin barrier and make symptoms worse,” Casey said. “Finding gentle cleansers and moisturisers that are aligned with the skin’s natural pH of 4.5-5.5 will help support the skin’s microbiome and barrier function.”
The American Academy of Dermatology also recommends switching to fragrance-free skin care products to reduce possible irritation.
“I also recommend to avoid petroleum-based skincare products, thick or heavy moisturisers, or oils that occlude the skin as these can exacerbate symptoms,” Casey said. “Also, discontinue any cortisone-based products.”
If the rash still hasn’t cleared up after eliminating potential irritants, it may be time to visit your dermatologist.
“Topical antibiotics have demonstrated efficacy against perioral dermatitis,” Casey said. “For more severe cases, oral antibiotics may be prescribed.”
Can I still slug my skin if I have a rash around my mouth?
If you notice a red, inflamed rash forming around your mouth (aka a perioral rash), does that mean it’s time to retire slugging from your bedtime routine? Not necessarily.
“It’s important to identify what type of perioral rash you have or are susceptible to before adopting or continuing a slugging routine,” Kung said.
While occlusives and topical treatments like cortisone creams can trigger and worsen perioral dermatitis, these treatments can help treat eczema.
“People with perioral eczema will benefit from skin slugging or by sealing in moisturizing agents with a thick ointment like Vaseline,” Kung said.
However, it’s important to remember that symptoms of perioral dermatitis and eczema can look very similar, with itchy, dry, med patches of skin, which is why it’s so important to consult with a dermatologist or medical professional.
How can I ensure my dry skin stays moisturised if I have perioral dermatitis?
While a perioral dermatitis diagnosis may mean skipping out on the thicker moisturisers and occlusives, there still is a way to make sure your skin gets the hydration it needs without triggering or prolonging your perioral dermatitis.
“Oil-free moisturisers that contain humectant ingredients that draw water into the skin, such as hyaluronic acid, can be very beneficial to dry skin without irritating perioral dermatitis,” Casey said. “Anti-inflammatory ingredients, such as niacinamide, in a lightweight moisturiser can also achieve the goal of hydrating the skin while reducing inflammation.”