Hyperpigmentation around mouth

Vitamin C can be effective in some cases; however it can also make skin darker due to skin irritation. We use it to lighten pigmented patches primarily on the face (melasma, skin lightening, skin brightening, treatment of post inflammatory hyperpigmentation as well as an antiaging serum to reduce oxidation). The problem with vitamin C is that good formulations have a low pH, this makes it highly irritating, especially if there is background inflammation.

1. Choose a low percentage formulation, L-ascorbic acid 5 to 10%.
2. Apply a thin layer of serum in the morning. Use 3 days in the week. 
3. Increase application amount & frequency as tolerated.
4. Avoid other potential irritants such as retinol, retinoids, salicylic acid, glycolic acid, etc.

If you develop skin irritation due to overuse, your dark areas around the mouth may worsen, hence why we prefer other skincare products to treat this area if the diagnosis is in doubt. Less irritating ingredients include niacinamide & azelaic acid (preferred topical of choice). 

Niacinamide & azelaic acid are preferred agents as they can reduce pigment around the mouth with relative safety. Azelaic acid is a dicarboxylic acid that possesses several mechanisms of action that contribute to its ability to clear pigmentation:

Azelaic acid inhibits the enzyme tyrosinase, which plays a key role in the production of melanin, the pigment responsible for skin colour. By blocking tyrosinase activity, azelaic acid reduces the synthesis of melanin, leading to a decrease in hyperpigmentation and an evening out of skin tone.

Azelaic acid exhibits anti-inflammatory effects, which can help reduce redness, swelling, and inflammation associated with pigmentation disorders such as melasma and post-inflammatory hyperpigmentation. By calming inflammation, azelaic acid can contribute to the improvement of overall skin appearance.

Overall, azelaic acid’s multifaceted approach to targeting pigmentation makes it an effective ingredient for treating various hyperpigmentation disorders, including melasma, post-inflammatory hyperpigmentation, and age spots. It is commonly used in topical formulations, such as creams, gels, and serums, for the treatment of pigmentation issues, either alone or in combination with other skin-lightening agents or exfoliants.

The recommended concentration is 20%, Azclear is a good brand.

Learn more about how to use glycolic acid 7% exfoliating toner  from The Ordinary to treat dark patches around the mouth.  

Glycolic acid can help improve the appearance of dark patches around the mouth area as it aids in exfoliation of pigmentation. This should NOT BE ATTEMPTED if your skin is inflamed as it will make pigmentation worse. 

To use the glycolic acid 7% exfoliating toner to treat perioral hyperpigmentation effectively, follow these simple steps:

• Buy the 7% glycolic acid toner from The Ordinary. It costs less than $14. 
• Cleanse the skin surrounding the mouth, then apply a small amount of the glycolic acid wash to your fingertips or a soft cloth. Gently massage the product onto the skin using circular motions for about 30 seconds to 45 seconds. 
• Leave on Briefly: Allow the glycolic acid wash to remain on the skin for a brief period, typically 1 to 1.5 minutes. Avoid leaving the product on for too long, as prolonged exposure to high concentrations of glycolic acid can lead to irritation or sensitivity.
• Rinse Thoroughly: After the designated time has passed, rinse the area thoroughly with lukewarm water to remove the glycolic acid wash. Ensure that all traces of the product are removed from the skin to prevent irritation.
• Pat Dry and Moisturize: Gently pat the skin dry with a clean towel and follow up with a moisturizer suitable for your skin type. Hydrating the skin after using glycolic acid can help prevent dryness and irritation.
• Frequency of Use: Start by using the glycolic acid wash once or twice a week, and gradually increase the frequency as tolerated. However, be cautious not to over-exfoliate, as this can lead to irritation or exacerbate darkening.

If you experience any signs of irritation, redness, or discomfort while using the glycolic acid wash, discontinue use for a few days, then recommence with less contact time. Remember, if you attempt to treat inflamed skin, it WILL lead to more pigmentation, you have been warned.

Vitamin B3 or niacinamide can be effective in some cases of perioral pigmentation.

Niacinamide is much safer than vitamin C as it is less irritating to use. Look for a 10% formulation & use it in the evening to dry skin. It can take up to 4 months before you see any differences. 

Niacinamide can help reduce pigmentation around the mouth area via –

Inhibition of Melanin Production. Niacinamide has been shown to inhibit the transfer of melanin to the skin’s surface, which can help reduce the formation of hyperpigmentation. By regulating melanin production, niacinamide can help lighten existing pigmentation and prevent further darkening of the skin.

Skin Barrier Function: Niacinamide supports the skin’s natural barrier function, helping to maintain moisture levels and protect against friction. Niacinamide can improve overall skin health and resilience, which may help reduce pigmentation over time. This can reduce skin irritation due to saliva, which is a frequent cause of pigmentation around the mouth. 

Anti-Inflammatory Properties. Niacinamide has anti-inflammatory properties that can help calm irritated skin, reducing redness and inflammation associated with perioral pigmentation.

Retinol can be effective as it works via 3 mechanisms.

1. Suppression of pigment production.
2. Compaction of the upper layers of skin (stratum corneum)
3. Increased turnover of the upper layer of skin, this may shed pigment. 

The problem with retinoids is that they are potentially irritating. To help reduce skin irritation, apply a small amount of retinol serum (0.1%) every second night to dry skin. Increase as tolerated. Do not start on Tretinoin or medically prescribed retinoids if the diagnosis is uncertain. 

*As with other topicals, if retinol or retinoids is applied to areas of inflamed skin, paradoxical darkening (via post inflammatory hyperpigmentation) will worsen the skin surrounding the mouth area. If in doubt, consult a medical dermatologist at Cutis Dermatology in Brisbane or The Skin Hospital in Sydney.

Darkening of the upper after laser or waxing can occur due to several reasons:

Post-Inflammatory Hyperpigmentation (PIH). In some cases, waxing or laser hair removal can cause post-inflammatory hyperpigmentation (PIH), which occurs when the skin responds to trauma or irritation by producing excess melanin. This can lead to dark spots or patches involving the upper lip. In darker skin types, the 1064 laser is preferred over the 755 laser. IPL should not be used to remove unwanted upper lip hairs in darker skin types. 

Chemical Sensitivity: Some individuals may experience a reaction to the ingredients in the wax or pre- or post-waxing products used, leading to irritation and darkening of the skin.

Flare up of melasma of the upper lip is not uncommon. Laser or waxing does not cause melasma (the cause is multifactorial), it merely unmasked the condition. 

In most cases, the solution is simple- pico laser coupled with skin care products to reduce pigmentation of the upper lip. 4-8 sessions over 3-6 months is the norm. 

The clinic who caused the pigment will usually pay for treatments to address the side effects. You may require legal representation if your provider refuses to acknowledge the side effects. 

*Our dermatologists may be required to provide a medicolegal report upon further questioning by a lawyer. Note: this report cost between $1500 to $2500 to generate, depending on the complexity of the matter. Medico Legal reports are not part of the initial consultation fee of $360 as they take 60 to 120 minutes.

Melasma is a chronic type of pigmentation that frequently affects the upper lip area, sparring the border. This pattern of melasma is one of the hardest to shift. 

Melasma patches also occur on the malar cheeks, forehead, temples, nose & mandibular areas.

Perioral dermatitis can lead to post inflammatory hyperpigmentation in darker skin types.  It is managed by medical dermatologists prior to the consideration of lasers. 

Perioral dermatitis is a common inflammatory skin condition that affects the area around the mouth, including the lips, chin, and sometimes the cheeks and nose. It is characterized by small, red bumps or papules, and may also include scaling, itching, or burning sensations. Perioral dermatitis can be persistent and recurrent, and its exact cause is not fully understood, although factors such as prolonged use of topical steroids, cosmetic products, hormonal changes, or certain oral medications may contribute to its development.

Treatment for perioral dermatitis typically involves a medical dermatologist. Here is how they approach things- 

Discontinue Triggering Products: Stop using any potentially irritating skin care products, including topical steroids, heavy moisturizers, makeup, or oral contraceptives, as these may exacerbate symptoms. If you are using fluorinated toothpaste, consider changing it as this has been linked to perioral dermatitis.

Gentle Cleansing: Use a mild, non-irritating cleanser to wash the affected area twice daily. Avoid harsh soaps, scrubs, or exfoliants, as these can further irritate the skin.

Treatments: Your dermatologist may prescribe topical treatments such as metronidazole cream or gel, azelaic acid cream, or sulphur-based preparations to reduce inflammation and clear up the rash. These medications are typically applied once or twice daily to the affected area. Most opt for systemic treatment (below) as it is more effective. 

Oral Antibiotics: Oral antibiotics such as tetracycline, doxycycline, or minocycline may be prescribed for a few weeks to help control inflammation and bacterial overgrowth.

Avoid Steroids: It’s important to avoid the use of topical steroids on the affected area, as they can worsen symptoms and lead to rebound flare-ups.

Perioral dermatitis can take several weeks to months to fully resolve, so it’s important to be patient and consistent with treatment. Follow your dermatologist’s recommendations and attend follow-up appointments as needed.

Only once your initial rash is treated do we recommend lasers to reduce pigmentation around the mouth. Our preferred laser is the pico laser. 4-8 sessions are recommended over 3 to 6 months. Lasers have a 90% success rate, providing perioral dermatitis does not recur. Azelaic acid is our preferred topical of choice, often coupled with anti-inflammatory agents if this rash occurs. 

Disclaimer: Though we are a specialist dermatologist clinic we do not manage medical conditions such as perioral dermatitis. Patients are referred to Cutis Dermatology in Brisbane or The Skin Hospital in Sydney. Perioral dermatitis management is via prescriptive medications, not laser therapy.

Lip lick dermatitis, also known as irritant contact cheilitis, is a common inflammatory condition affecting the lips. It typically occurs due to repeated licking of the lips, leading to irritation and inflammation of the skin. The constant licking strips the natural oils from the lips, causing them to become dry, cracked, & irritated. Saliva is the irritant. It is more common in children, patients with atopic eczema & can be associated with anxiety. Lip lick dermatitis is exacerbated by environmental factors such as cold weather or exposure to irritants- most commonly due to patients attempting to treat pigmentation of the mouth area with inappropriate skin care. 

Symptoms of lip lick dermatitis may include:

1. Dryness and flakiness of the lips
2. Redness and swelling
3. Post inflammatory pigmentation, leading to darkening of the skin surrounding the mouth area.
4. Cracks or fissures in the skin of the lips
5. Itching or burning sensation
6. Soreness or discomfort, especially when eating or drinking

Treatment for lip lick dermatitis typically involves:

1. Breaking the habit of lip licking: Encouraging individuals to avoid licking their lips excessively can help prevent further irritation and allow the skin to heal.
2. Moisturizing the lips: Applying a gentle, fragrance-free lip balm or emollient regularly can help restore moisture to the lips and protect them from further irritation.
3. Avoiding irritants: Individuals with lip lick dermatitis should avoid using lip care products that contain potential irritants such as fragrances, flavours, or menthol.
4. Using barrier creams: In severe cases, a barrier cream containing ingredients such as petrolatum or dimethicone may be recommended to provide a protective barrier and promote healing.
5. Treating underlying conditions: If lip lick dermatitis is caused by an underlying condition such as allergies or eczema, addressing the underlying cause may be necessary to effectively manage the condition.
6. Addressing skin hyperpigmentation around the mouth area with pico lasers & pigment correctors. This is the FINAL step. Dermatitis has to be in remission if you want effective, long-lasting results.

In most cases, lip lick dermatitis can be managed effectively with proper skincare and behaviour modification. This condition is managed by medical dermatologists at Cutis Dermatology in Brisbane, or the Skin Hospital in Sydney. Some cases of lip lick dermatitis require investigations such as patch testing for allergies.

Food allergens that can lead to inflammation around the mouth, known as oral allergy syndrome or food-induced allergic contact dermatitis. This can lead to post-inflammatory hyperpigmentation, resulting in darkening of the skin around the mouth. A medical dermatologist or an allergist specializing in contact dermatitis can assist.

Certain fruits such as apples, bananas, kiwi, peaches, and melons can trigger allergic reactions in some individuals, especially those with pollen allergies. 

Some vegetables like tomatoes, carrots, celery, and potatoes may cause oral itching or swelling in sensitive individuals.

Peanuts, almonds, walnuts, and other tree nuts are common allergens that can cause oral symptoms, including itching or tingling in the mouth. Sesame seeds and sunflower seeds are known allergens that may cause oral allergy symptoms in susceptible individuals.

Certain legumes such as soybeans, lentils, and chickpeas can trigger oral allergy symptoms in some people.

Spices like cinnamon, coriander, and mustard can sometimes cause oral itching or swelling in individuals with spice allergies.

Shellfish, including shrimp, crab, lobster, and clams, are common allergens that can cause oral allergy symptoms in sensitive individuals.

Certain types of fish, such as salmon, tuna, and cod, may trigger allergic reactions in some people, leading to oral symptoms.

Eggs are a common allergen that can cause oral allergy symptoms, including itching, swelling, or tingling in the mouth.

Some individuals may experience oral allergy symptoms after consuming dairy products such as milk, cheese, or yogurt, especially if they have a dairy allergy.

A physician can perform allergy testing and provide guidance on allergen avoidance and treatment options. This is the first step in breaking the cycle that leads to post inflammatory hyperpigmentation. Once your allergen has been identified do we perform lasers to remove dark patches around the mouth.

Disclaimer: Though we are a specialist dermatologist clinic we do not manage medical conditions such as perioral dermatitis. Patients are referred to Cutis Dermatology in Brisbane or The Skin Hospital in Sydney. Perioral dermatitis management is via prescriptive medications, not laser therapy.

The list is long & exhaustive, for complex cases your medical dermatologist who specializes in patch testing will provide you with a list after your allergies have been identified. 

The allergen commonly found in toothpaste is sodium lauryl sulphate (SLS). Sodium lauryl sulphate is a surfactant and detergent agent used in many oral care products, including toothpaste, to create foam and help remove debris and plaque from the teeth. However, some individuals may experience allergic reactions or sensitivity to SLS, which can manifest as irritation, redness, or inflammation in the oral cavity. As a result, toothpaste formulations without SLS are available for those who are sensitive to this ingredient. Other allergens include parabens, cinnamal, cinnamon, anethole, propolis, fluoride salts, & azulene. Flavourings include spearmint, peppermint & menthol. 

Denture cleaner has very rarely been reported to cause contact allergy; the allergen is ammonium persulphate. 

Fluorinated toothpaste can lead to perioral dermatitis, in turn resulting in post inflammatory hyperpigmentation & dark patches around the mouth area.

Patch testing is detective work to find out if your pigmentation around the mouth area is due to allergies. It involves testing for common allergens found in cosmetics, toothpaste, & foods. A series of ‘patches’ are stuck on your back (usually during winter), & the results are interpreted by a dermatologist. 

Patch testing is conducted by a medical dermatologist. We refer our patch testing patients to Cutis in Brisbane or the Skin Hospital in Sydney.

Natural remedies & home therapies are unsuccessful, however if you would like to give natural therapy a go, here is the guide –

• Glutathione 500 mg daily.
• Add glycolic acid 7% exfoliating toner washes daily.
• Apply niacinamide (vitamin B)  or azelaic acid in the evening. 

The highest success for DIY or home remedies is to use a 7% glycolic acid exfoliating wash, which is discussed below.

The 4 main conditions that are super hard to treat are –

1. Genetic causes including constitutional perioral pigment & pigmentary demarcation lines. Lasers can be effective in some cases, however it requires up to 10 sessions over many months. Recurrence is frequent. We cannot change your DNA. 
2. Acanthosis nigricans is an uncommon cause of pigmentation around the mouth. It is very resistant to laser treatment & should be managed by endocrinologist, dietitians & medical dermatologist.
3. Lip lick dermatitis. It is a habit; most patients deny it. We can modify habit with lasers. 
4. Allergic contact dermatitis whereby the allergen or irritant is unknown. An experienced allergist or patch test dermatologist is required for this job.

Cleaning the underarm area with the correct cleanser is important. Dermatologists endorse QV products as they are specially prepared for dry or sensitive skin. 

QV Gentle Wash, Cetaphil, or the La Roche Posay line for sensitive skin are all endorsed by dermatologists. Don’t spend big on cleansers, use simple products to reduce skin irritation & inflammation.

The Melasma Clinic has access to over 40 lasers & energy devices. Picoway & Picosure Pro are the lasers of choice for treating perioral pigment. 

We also employ Q switch lasers such as RevLite, Hollywood Spectra & QRas lasers. 

Your medical dermatologist will guide you as to the creams we prescribe (the real deal without the fluffy skin care).  Three types of creams can be used, depending on the cause. 

1. Calcineurin inhibitors such a tacrolimus or pimecrolimus (Protopic or Elidel). This group of creams do not have the long-term side effects of steroids. They can be effective in preventing post inflammatory hyperpigmentation.
2. Pigment inhibitors. They include hydroquinone, arbutin, azelaic acid, ascorbic acid & cysteamine. We use compounded formulations that are between 5 to 10 times stronger than over the counter skin care.
3. Corticosteroids to reduce inflammation. Example: Advantan Fatty ointment. This is used in a pulse manner (your dermatologist will guide you). Steroid creams are only useful in the very early phase of inflammation.

Dermatologists at The Melasma Clinic are procedural, namely we perform procedures such as lasers & peels. Though we can provide second options, diagnose & investigate all forms of perioral hyperpigmentation, we do not provide ongoing medical management as this entails frequent visits, follow ups & prescriptive medications. We refer patients to Cutis Dermatology in Brisbane, or the Skin Hospital in Sydney for joint management with a medical dermatologist.