054: Holistic Approach to Perioral Dermatitis w/ Dr. Sarah Villafranco

Perioral dermatitis is an incredibly frustrating skin condition because it is so difficult to treat. My guest today has some tips for reducing perioral dermatitis flares.

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My guest today is Dr. Sarah Villafranco, a noisy advocate for cultivating joy and health in everyday life. During ten years practicing emergency medicine, she observed the broad spectrum of human wellness and illness, and wanted to empower her patients more in their daily choices.

With her line of luxury, natural skincare, she hopes to increase the quality of the ingredients people are absorbing through their skin, and employs a less-is-more approach to conditions such as dermatitis, acne, and eczema. She is invested in shifting the conversation from beauty to skin health, and to discussing the privilege of aging in a positive light.

Join us as we dive into perioral dermatitis, and her dos and don'ts for managing this chronic skin rash.

Has your perioral dermatitis improved with a healthier diet and removal of fluoride and SLS? Tell me about it in the comments!


In this episode:

  • What is perioral dermatitis (PD)?
  • Dr. Sarah's experience with PD
  • What are the most common causes of PD?
  • Why can applying oil to PD make it worse?
  • Can antibiotics help?
  • Some ingredients that can help people with perioral dermatitis.



“[Perioral dermatitis] can have the bumps that often come with acne and the redness and it can have the dry flaky tightness that comes with eczema.” [2:01]

“Some dermatologists are wising up and understanding that topical steroids are one of the leading causes of perioral dermatitis.” [12:45]

“We should not use parabens because they are proven to disrupt hormone cycles and shorten gestational age at birth.” [17:25]

“It's unfortunate, but if more dermatologists knew that they could ask patients to stop using SLS and to stop using fluoride and to work actively on stress management and not to use oils on their skin, I think a lot of people could heal themselves without antibiotics with two to four weeks of behavioral changes.”



Find Dr. Sarah and Osmia Organics online

Osmia Organics blog

Osmia Organics Black Clay Facial Soap

Osmia Organics Purely Simple Face Cream

Want to try some amazing toothpaste with hydroxyapatite (+ other products)? Try RiseWell!

CLICK HERE to listen to more info on the problems with fluoride in our water!

Follow Dr. Sarah on Facebook | Twitter | Instagram | LinkedIn


054: Holistic Approach to Perioral Dermatitis w/ Dr. Sarah Villafranco FULL TRANSCRIPT

Jennifer: Hi everyone. Welcome back to today's show. I have a very special guest with me who I am thrilled that she is here and one reason why is that we have not talked about this topic yet, so stay tuned. We'll talk about it in a moment, but first I want to introduce my guest. Her name is Dr. Sarah Villafranco and she is a noisy advocate for cultivating joy and health in everyday life. During 10 years practicing emergency medicine, she observed the broad spectrum of human wellness and illness and wanted to empower her patients more in their daily choices. With her line of luxury natural skincare, she hopes to increase the quality of the ingredients people are absorbing through their skin and employs a less is more approach to conditions such as dermatitis, eczema, and acne. She is invested in shifting the conversation from beauty to skin health and to discussing the privilege of aging in a positive light. Thank you so much for joining me, Sarah. So we're going to talk today about Perioral dermatitis, which I will be honest, seems to be one of the trickiest of the ‘dermatitises' that is out there.

Dr. Villafranco: So many tongue twisters, I call it PD for short.

Jennifer: So why don't you talk a little bit about PD and your personal, cause you've actually gone through this. Can you share a little bit about what it is and your experience?

Dr. Villafranco: Absolutely. So perioral means around the mouth and dermatitis just means angry skin. It's a very broad catchall term. And so really what it looks like is a mix of acne and Eczema. So it can have the bumps that often come with acne and the redness and it can have the dry flaky tightness that comes with Eczema. And the places that you see it are in the folds of your nose, sort of the sides of your nose. And then it can sort of track down the smile lines and then around the chin. And so it feels terrible. Some people refer to it as muzzle rash, which I think is particularly cruel because you're already feeling bad about yourself and now you've just been referenced by a dermatologist as having muzzle rash. So yeah, that is sort of what it looks like. It can look red, it can look bumpy, it can look quite painful. I've had people send me pictures that just make my heart hurt because I know that they've been locked in their apartment for weeks, unable to face the world with face in such a state of distress.

Jennifer: Hmm. And does this affect, I mean I'm familiar with women having it because I've had female clients with it, but do you know, does it affect kids or teenagers or does it affect men?

Dr. Villafranco: Everyone. Yeah, so I see it a lot in young kids who are on a steroid inhalers for asthma. I see it a lot in men and strangely I have a pretty big population of people who are 60 and up who are experiencing dermatitis. And you know, we can go into the various causes for it, but because the condition is caused by different factors for every single person who has it, it really can affect a huge broad range of people.

Jennifer: Mm. And since you did have it before we go into, what are some of the reasons why, what was your experience with it? Briefly?

Dr. Villafranco: Yeah, I mean I do have it, it's not a past tense thing and it rarely is a past tense thing. So people who have it will be able to heal themselves and be able to diminish the symptoms to the point that they are no longer visible or noticeable. Even, you know, when it's good, even to myself, I don't notice it, but if I misbehave or if I'm hugely stressed or if there is some sort of trigger for me or for anyone else who has PD, it's going to come back. And for that, in many ways I'm grateful. I think of PD as my health barometer. When my skin starts to show me irritation, I know that something's out of balance. And that I need to bring some awareness and some attention into caring for myself. So I first noticed it when I was 36; I'm now 45 for a few more weeks. And when I was 36, I started seeing these bumps, I'm mostly around the folds of my nose and then it sort of spread to my chin and it was just, it was never horrible. So I was never one of those extreme cases, but it was pretty constant and it was red and tight and irritated and dry. And I felt like everything I put on it made it worse. And at the time I was in transition from, you know, I was thinking about leaving the emergency room to do something else with my life and I wasn't quite sure what that was. But I was fresh out of a soap making class that had fired me up, like right to my core. I was so excited about making soap. So then I was sort of playing with a lot of natural ingredients and I tried a bunch of different products on my face and most of them made things worse. And eventually that process led me to develop some products a few years later that that really helped my condition. But, you know, I think, let's see, I had my second daughter when I was 33. My mother died that same year. So it was a pretty stressful stretch for me. And then I was sort of like evaluating what medicine meant to me and how I wanted to practice it. So it was a pretty turbulent period in my life. And I would say that I was going through some hormonal shifts and some stress shifts that probably, you know, added up with a few other things to create the condition in me personally.

Jennifer: Yeah. And, and so mentioning stress, and I'm sure too if you're eating a really junk filled Standard American Diet, that's probably not going to help either because it can be very highly inflammatory. But what do you consider some of the leading causes of PD? Just across the board? What can you rattle off for us? Because I'm sure people have like looked around online, but they might be like, I don't know what this could be and maybe there is something they haven't come across yet.

Dr. Villafranco: Yeah. And you know, googling things is both a blessing and a curse, as you know. I've had many people say, you know, emailed me at three in the morning saying, I've been sitting here with a mask of powdered sugar and olive oil on my face for three hours and I'm thinking that's just not a good idea. And they got it from Google. And so you just have to sort of curate your Google searching a little bit. So for me because of that I've seen really consistently, are fluoride toothpaste and a lot of people are using, you know, more and more natural products and even a product like Toms or there are a couple of other natural brands, they have fluoride in them. And additionally, Sodium Laurel or sodium laureth sulfate in anything and by anything, I mean, anything that foams, so sodium lauryl sulfate or sodium laureth sulfate, we'll call it SLS. SLS is used to create bubbles or foam. So it is in laundry detergent, even like Seventh Generation laundry detergent. It is in many toothpastes. It is in almost every shampoo out there, especially if you didn't buy it at Whole Foods. I'm thinking there's one more category where you see SLS sometimes. You see it in your dish soap as well. And so getting rid of SLS sort of throughout your entire household is a critical piece of healing from perioral dermatitis. So fluoride, SLS, stress is number three, and it's involved in every single case of perioral dermatitis. Hormonal shifts: so a lot of times women develop it when they're pregnant immediately, after pregnancy, when they stopped nursing, or when they go through menopause. And so I see those, those spikes. And within that, a lot of women have symptoms of dermatitis more in the days before their cycle and then it recedes a little bit afterwards. So those are sort of the top ones. There are certain foods and other things that can exacerbate it. So I think synthetic fragrance usually makes PD worse. If you drink a ton of coffee that can irritate it. And cinnamon can also irritate dermatitis. I know sort of depressing because a cup of coffee with a little cinnamon is one of my favorite treats. So I try to save it for when my skin is happy.

Jennifer: Well, and one interesting thing that I noticed and I've been told about PD is that applying oils to the face can sometimes make it worse. Let's talk about that.

Dr. Villafranco: Yeah. PD wants water. That's what it wants. And it's tricky because you'll find other, I mean, I'm a doctor and I'm a brand founder, right? But you'll find other brand founders who will tell you, no, no, this oil is perfect for dermatitis. And I'm just here to tell you it's not true. And I don't know why. Like I have done so much research to try to figure out why oils make this condition worse and I can't figure it out. But it's true. And I as a guinea pig can speak from that angle too, because when I was developing Osmia, I was testing all kinds of oils on my face because I wanted to know how they absorbed, and how they penetrated, what they felt like on my skin. And I wanted to test everything before I created formulations and my dermatitis just went bonkers with oil. And you know, one thing I've seen a lot of lately is I'm sure you've seen too is the the rage with oil cleansing. So many people oil cleanse every day and they're still having dermatitis and it's really the oil cleansing. It's keeping them in a state of aggravation. So it wants water. And that's why when I ended up developing products, the products that I developed have a higher percentage of water than a lot of skincare products do. Even like for example our Purely Simple face cream, you know, most face creams are like maybe 65% water soluble ingredients and ours is up closer to, you know, 78% because the skin really, really wants to be hydrated and oils don't hydrate.

Jennifer: It's interesting that this particular condition like flies in the face of so many other things that you need to do for like Eczema even. It is almost like a beast in and of itself. And it's very frustrating. And you know, I had one client who decided and we talked about it, you know, I'm not anti anything. I think what's worse is when we just say we're taking all of these things off the table. I think there's a time and a place for modern medicine. And she ended up having to go with an antibiotic to see if they could finally resolve things. And that actually did help. So out of curiosity, did you ever have any experience taking an antibiotic for this or just any thoughts on that route?

Dr. Villafranco: Yeah. So when you go see a dermatologist, most likely if you have perioral dermatitis, you'll leave the office with a prescription for oral antibiotics, for a topical antibiotic and for a topical steroid cream. So those are the three things. Now, some dermatologists are wising up and understanding that topical steroids are one of the leading causes of perioral dermatitis. So that was a vicious cycle for many decades. And I think dermatology is finally catching up with that. So hopefully now they're going to send you home. They'll send you with both forms of antibiotics. And what I found is that the topical antibiotics made things worse, but if people do feel that they need to go the antibiotic route, I encourage them to do four to six weeks of oral antibiotics, systemic antibiotics. And you know, I'm not sure why that's the case either. Like I don't think that this condition has a bacterial etiology. But I do think that a lot of the antibiotics that are used for skin, usually they'll put you on one of the tetracycline drugs and they have an anti-inflammatory effect that can sort of break the cycle in a way. So you can do, you know, let's say a month of oral antibiotics and while you're doing that, you're cleaning your house out of fluoride and SLS and you're working on stress management and you're making sure that your hormones are as balanced as they can be and you're supporting yourself with an anti-inflammatory diet. It sort of gives you time to build up a support system that will help the results of the antibiotics endure because it doesn't, if you take the antibiotics and then you'd go back to your Tide laundry detergent and McDonald's, like it just doesn't matter. It's coming back.

Jennifer: And for those of you who are listening to this and you're having this like full stop gasp, like, oh my gosh, Jen is talking about antibiotics and how they might be helpful because you want to do all natural stuff. The whole thing that I've found and discovered, sometimes we have to keep all the cards on the table and it's not a disaster. It's not always going to be a disaster. Sometimes an antibiotic might be necessary in certain cases. You know, sometimes the antimicrobial herbs just aren't as effective unfortunately. And so it's not to say that everyone has to choose that route, but I also want you guys to have all of the options in front of you to choose. That's why I think this is an important conversation to have because PD is so, so aggravating and it's so difficult to get rid of and I can understand with the feelings of shame and embarrassment and whatnot, just wanting to be normal.

Dr. Villafranco: I totally agree with that, Jen. I would just interject and say that, you know, it's unfortunate, but if more dermatologists knew that they could ask patients to stop using SLS and to stop using fluoride and to work actively on stress management and not to use oils on their skin, I think a lot of people could heal themselves without antibiotics with two to four weeks of behavioral changes. I think, you know, I don't know. I bet half of them at least could go without. I'm a doctor. I'm not anti antibiotics either. I think sometimes they are necessary, but I think that the lifestyle modifications are so critical to the longterm success of it, but it's worth trying them for two to three weeks and seeing if like, oh my goodness, look at this. I stopped oil cleansing and it's 50% improved over three days. Yeah.

Jennifer: One of the reasons I invited you here was because one of my clients who had PD found your black soap and you know, she was like, have you heard of this? And I was like, no. I went and I read all these amazing reviews of people it'd really helped. So can we talk a little bit about, you know, I know that you spent a lot of time figuring out how to formulate products that will be helpful in this regard. So what are some of the things that you've found really help people and maybe some ingredients that they should look for and whatnot? Because I know that with Osmia you've got a really great line of incredible products that are based on all natural ingredients and they don't have a lot of these things that you discussed in them, which is great.

Dr. Villafranco: Any of them. Yeah, I mean we're pretty strict about ingredients and you know, I really went through and did my homework from a medical perspective because like you said, I don't want to just not do something because it's trendy or you know, people like, oh my gosh, no parabens well, okay, why? Like let's research that exact question and figure out why should we not use, should we really not use parabens. Right. And for me, the answer on that one was a clear no, we should not use parabens because they are proven to disrupt hormone cycles and shorten gestational age at birth. And I mean they're like really objective measurements of the degree to which they disrupt the human hormone cycles. Right? So that was a clear one. But it's other things. You know, like palm kernel oil for example, that's a really controversial topic in the skincare world and people say, you know, I'm never using palm. Well it turns out if you can use like sustainably sourced palm kernel oil, that might actually be better for the world. Because if you're sourcing it from places that don't have orangutan populations, you're actually supporting a culture and a community and jobs and you're doing it with a crop that uses way less land than most other crops. So it's a question of sort of like really thinking through the issues. And so that's sort of just to say like that's how we as a company have gone through and selected our ingredients. What we use and what we don't use is by really deeply doing the homework on every ingredient. So for me and, and strangely, the way that our black clay facial soap came about was not in a particularly scientific way at all. I remembered when I was growing up that my friend's mom used to use this Erno Laszlo soap. Do you remember that stuff? It's like this gorgeous black bar of soap, right? And it just looked so posh and like fancy. And I just remember watching her use it and thinking she's so elegant and luxurious. So I really started out to make a black bar of soap. And to do so I grabbed some black clay and some Dead Sea mud and I made this really lovely bar of soap and we used organic coconut milk and avocado oil and you know, all kinds of yummy, nourishing oils for the skin and turned them into soap. So then I started using it and for the first time in several years saw my dermatitis start to recede. And I thought, okay, you're imagining this. And so I stopped using it and the symptoms came back and then I started again and it started to recede again. And then I started passing it out to everyone I knew who might have a little whiff of dermatitis. Because if you look around like I mean, so many people have this condition and more and more people started saying, wow, this is really helping. So then I sort of went back and looked at the ingredients to try to figure out why they might be helpful. And my best answer is that the Dead Sea mud is really powerful in terms of anti-inflammatory and some inherent antibiotic properties basically. So it's very high in sulfur and minerals. Minerals are also prevalent in the black clay. And what minerals do for the skin is essentially turn each skin cell from a raisin into a grape. They sort of plump the skin cells. And so that seems to be the effect of this soap has had them, I think they're like 800 plus reviews on our website for this little bar, black magic. And I feel so lucky that I had this skin condition, develop the soap, figured out that it was helping me. And you know, I'm not out there making claims about it, but it is, it is really wonderful how many people it has helped to sort of recover from this skin condition.

Jennifer: And actually as we're talking about this too, I'm thinking somebody might say, wait, but my skin is also tight and I want to moisturize. But now you're saying I can't use oils, so what would I use to moisturize?

Dr. Villafranco: So again, oils don't add moisture or they don't hydrate at all cause ‘h y d r' means water. So unless you're using an oil on wet skin, it's not hydrating or moisturizing at all. It is softening and it is nourishing and it brings great ingredients to the skin. But unless you are providing water, it's not adding moisture at all. And to test this at home, you can apply like sunflower oil to one arm that's dry and then wet the other arm and apply some sunflower oil to that one and wait 10 minutes and feel the difference. The dry skin will just be, you'll just be greasy. It's going to be soft, but it's kind of greasy. But the one that you applied wet, will be really velvety and smooth. So to moisturize I recommend a light facial cream. So we make that, like I said, that Purely Simple face cream it, that's what I made to try to soothe my skin. It was sort of my answer to set up without the mineral oil and petroleum and you know, just a really simple ingredient list. Nothing fancy but really pure and with a very low percentage of essential oils so that even really sensitive skin can handle it.

Jennifer: Awesome. That's a great point. You know, I was thinking as we were discussing this, I'm like, it's good to know what you to wash your face with, but it's also important to know what to put on it afterwards. And the fact that you have options is a good thing to know. Especially cause now it's like wait: everything I see now is plant oils, plant oils, plant oils. But I'm not supposed to use that so what do I do? And I'm glad that you've actually, it's really nice actually that you've had that experience personally with this to know that this stuff is helpful. Well, it has been for you. And then you've gotten the feedback from so many people that it's also been helpful for them because PD again is just so just so complicated and it's a frustrating experience to go through. And I will also agree with you that the stress component is so important. And I think oftentimes people take it for granted and they just go, well, what if I do a massage a month? And I'm like, no, I don't think one massage is really chronic. It's great. It's good, good start. Right? It's not the full fix. So I do think we should also say too, stress has gotta be you gotta think about what, how you can start to better manage and deal with stress in your life. But I just want to thank you so much for being a guest today on the podcast. I hope that we can have you some time and I want to encourage everyone to go over to your website and check out all of the products and how can they find you?

Dr. Villafranco: Well, let's see. So the website is a great suggestion because especially if you have dermatitis or really, you know, acne or Eczema or any other skin condition, you're struggling with. Our blog is a real wealth of information. I write a lot of the articles there and they're all backed by lots and lots of hours of research by me. It's nice because you kind of get the, you know, it's not exactly free medical advice, but it's close. I have a pretty common sense approach to things too. You know, I'm really am a bit like you where it's like we don't need to go like radically crazy in any direction. We can, we can put together a good common sense plan that is doable and sustainable for you. And then if you're an Instagrammer, definitely follow us on Instagram because you will see an occasional Osmia product but more you will see beautiful blue Colorado skies and Border Collies and my daughters and nature and running and hiking and yoga and all kinds of fun stuff.

Jennifer: Yeah, it definitely is beautiful on the website is osmiaorganics.com and the Instagram handles also osmiaorganics. It's very easy to find you, but we'll put all of the links in the show notes and if you guys decide that you want to give the products to try a few sign up for their email list, you'll get 10% off. So it's a great opportunity to give things a test drive and see if they work for you. But I will tell you, I have really enjoyed, I have that recovery salt bath and I absolutely love it. So I've really appreciated getting to know your brand and just you and your story. And I, I also deeply appreciate you sharing your wisdom here with everyone because again, this has been something that frustrates people to no end. This was, this was a great conversation. This is, this is definitely awesome.

Dr. Villafranco: I'm here to chat anytime and I so appreciate your straightforward approach to helping people toward their greatest health and happiness. And that's a real gift that you have and they are, they're lucky to be in your flock.

Jennifer: Well, thank you very much. And I hope we can have you back, Sarah.

Dr. Villafranco: Yeah. Great. Thanks so much.

“[Perioral dermatitis] can have the bumps that often come with acne and the redness and it can have the dry flaky tightness that comes with eczema.”

Jennifer Fugo, MS, CNS

Jennifer Fugo, MS, CNS is an integrative Clinical Nutritionist and the founder of Skinterrupt. She works with women who are fed up with chronic gut and skin rash issues discover the root causes and create a plan to get them back to a fuller, richer life.

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