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Author: Reviewed and updated by Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand; Vanessa Ngan, Staff Writer, February 2014. Further updated in January 2016.
Periorificial dermatitis is a common facial skin problem characterised by groups of itchy or tender small red papules. It is given this name because the papules occur around the eyes, the nostrils, the mouth and occasionally, the genitals.
The more restrictive term, perioral dermatitis, is often used when the eruption is confined to the skin in the lower half of the face, particularly around the mouth. Periocular dermatitis may be used to describe the rash affecting the eyelids.
Periorificial dermatitis and its variants mainly affect adult women aged 15 to 45 years. It is less common in men. It may affect children of any age.
People with periorificial dermatitis are often using topical or inhaled corticosteroids.
The exact cause of periorificial dermatitis is not understood. Periorificial dermatitis may be related to:
Periorificial dermatitis may be induced by:
The characteristics of facial periorificial dermatitis are:
In contrast to steroid-induced rosacea, periorificial dermatitis spares the cheeks and forehead.
Genital periorificial dermatitis has a similar clinical appearance. It involves the skin on and around labia majora (in females), scrotum (in males), and anus.
Clinical features of perioral dermatitis
Granulomatous periorificial dermatitis is a variant of periorificial dermatitis that presents with persistent yellowish papules. It occurs mainly in young children and nearly always follows the use of a corticosteroid. There is a granulomatous perifollicular infiltrate on histopathology.
Steroid rosacea presents with steroid-induced, large facial papules, papulopustules and telangiectasia on the mid-face, including forehead and cheeks.
Rebound flare of severe periorificial dermatitis may occur after abrupt cessation of application of potent topical steroid to facial skin.
The presentation of periorificial dermatitis is usually typical, so clinical diagnosis is straightforward. There are no specific tests.
Skin biopsy shows follicular and perivascular chronic inflammation similar to rosacea.
Periorificial dermatitis responds well to treatment, although it may take several weeks before there is a noticeable improvement.
Topical therapy is used to treat mild periorificial dermatitis. Choices include:
In more severe cases, a course of anti-inflammatory oral antibiotics may be prescribed for 6–12 weeks. This helps to reduce the rebound flare seen after stopping the topical steroid.
Periorificial dermatitis can generally be prevented by the avoidance of topical steroids and occlusive face creams. When topical steroids are necessary to treat an inflammatory facial rash, they should be applied accurately to the affected area, no more than once daily in the lowest effective potency, and discontinued as soon as the rash responds.
Periorificial dermatitis sometimes recurs when the antibiotics are discontinued, or at a later date. The same treatment can be used again.
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