Author: Dr Ian Coulson, Consultant Dermatologist and Editor-in-Chief, 2022.
Edited by the DermNet content department
This 20-year-old woman has sore red spots around both eyes; her only other problem is allergic rhinitis for which she uses a steroid nasal spray.
This is periocular dermatitis; it often coexists with perioral dermatitis. It produces small red papules and occasionally pustules firstly at the lower lateral lid, then may spread around the entire periocular skin. It is often sore rather than itchy. It is quite distinct from other causes of periocular eczema, such as atopic, seborrhoeic, or contact eczema.
Many cases of perioral and periocular dermatitis (periorificial dermatitis) are due to either intentional or inadvertent topical steroid exposure to the affected sites. Back spray from the nasal steroid aerosol onto the periocular skin has caused this young woman’s problem.
Treatment involves improvement of spray technique to prevent accidental exposure or withdrawal of topical steroids. Oral tetracyclines are very effective and may be needed for a few months; repeat courses may be given should it recur.
Other oral antibiotics such as macrolides and metronidazole are effective. Topical therapies such as metronidazole, clindamycin, and calcineurin antagonists have been used but are often not tolerated.
