What is perioral dermatitis?
Perioral dermatitis is a common facial skin problem in which groups of itchy or tender small red papules (bumps) appear around the mouth. The papules spare the skin bordering the lips (which then appears pale) but develop on the sides of the chin, then spreading to include upper lip and cheeks. The surrounding skin may be pink, and the skin surface often becomes dry and flaky.
When provoked by topical steroid use, perioral dermatitis is often called steroid rosacea.
Periorificial dermatitis is the name used for the same disorder when it spreads to sites other than around the mouth. These include:
- Around the nose
- On the eyelids and around the eyes (‘periocular’ dermatitis)
- On or around genital skin
- Around the anus.
Granulomatous periorificial dermatitis
Granulomatous periorificial dermatitis refers to a papulo-pustular periorificial disease that shows a granulomatous perifollicular infiltrate on histopathology. It presents with persistent yellowish papules around the mouth.
Who gets perioral dermatitis?
Perioral dermatitis and its variants mainly affect adult women. These disorders are uncommon in men. Perioral dermatitis may occasionally affect prepubertal children.
What is the cause of perioral or periorificial dermatitis?
The exact cause of perioral dermatitis and/or periorificial dermatitis is not understood. It is thought to be a variant of rosacea, which is now known to be due a complex activation of the innate immune system. Patients who are susceptible to perioral dermatitis tend to have an oily face, at least in the affected areas. The rash may be induced by:
- Neglecting to wash the face
- Certain cosmetics, such as face creams, make-ups and sunscreens especially those that are petrolatum or paraffin based or contain isopropyl myristate
- Topical steroid creams, whether applied deliberately to facial skin or inadvertently
- Nasal steroids and steroid inhalers
- The use of fluorinated toothpaste.
- Hormonal changes and/or oral contraceptives.
Perioral dermatitis may be related to an imbalance of, or immune reaction to, proliferating bacteria and/or yeasts in the hair follicles.
What is the treatment for perioral dermatitis?
Luckily perioral dermatitis responds well to treatment.
- Discontinue applying all face creams including topical steroids, cosmetics and sunscreens (zero therapy).
Note: when a steroid cream is discontinued, the rash may get worse for a few days before it starts to improve. Minimise face creams in the affected areas, as the rash is very likely to reappear.
Choose a liquid or gel sunscreen.
- Wash the face with warm water alone while the rash is present. When it has cleared up, use a non-soap bar or liquid cleanser if you wish.
Depending on the severity of dermatitis, your doctor or dermatologist may also prescribe topical or systemic therapy. It may take a few weeks after starting treatment before there is noticeable improvement.
- In mild cases, topical erythromycin in a nongreasy base may be used.
- Other topical choices include metronidazole gel, pimecrolimus cream and azelaic acid preparations.
- In more severe cases, a course of oral antibiotics for 6-12 weeks may be prescribed. Most often, a tetracycline such as doxycycline is recommended. Oral erythromycin is used during pregnancy and in prepubertal children.
- Oral isotretinoin may be used in cases that don’t respond to other treatments.
Perioral dermatitis sometimes recurs when the antibiotics are discontinued, or at a later date. The same treatment can be used again.
- Hall CS, Reichenberg J. Evidence based review of perioral dermatitis therapy. G Ital Dermatol Venereol. 2010 Aug;145(4):433-44. Review. PubMed PMID: 20823788.
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