Perioral Dermatitis

Perioral dermatitis is a chronic papulo-pustular facial dermatitis. The aetiology of perioral dermatitis is unknown but the inappropriate and excessive use of topical steroids for minor skin problems of the face often precedes development of perioral dermatitis. Perioral dermatitis tends to be chronic.

• The incidence is estimated to be 0.5-1%. The incidence has decreased in recent years and this is likely to be due to greater awareness of the problems of prolonged use of topical steroids.
• Predominantly affects women aged 20-45 years, who account for an estimated 90% of the cases.¹
• The number of male cases is increasing and this is assumed to be because of changes in their use of cosmetics.

An underlying cause cannot be detected in all patients. The aetiology of perioral dermatitis is unknown.

• Topical steroid preparations. No clear correlation exists between the risk of perioral dermatitis and the strength of the steroid or duration of use.
• Cosmetics.²
• Fluorinated toothpaste.
• Physical factors: UV light, heat, and wind worsen perioral dermatitis.
• Candidiasis has been suggested as a provoking factor.
• Miscellaneous: Hormonal factors are suspected because there may be a premenstrual deterioration. Oral contraceptives may also be a factor.

• Erythema, fine papules and pustules around the mouth and cheeks.
• The pale area adjacent to the border of the mouth is characteristic.
• Occasionally the eruption can be more widespread, when the eyelids and forehead are also affected.
• Sensation of burning and tension. Itching is rare.
• Skin lesions occur as grouped follicular reddish papules, vesicles and pustules on an erythematous base.
• The predominant locations of lesions are the perioral area, nasolabial fold, and lateral portions of the lower eyelids.

• Acne rosacea
• Acne vulgaris
• Contact dermatitis.

• Patients initially need an evaluation of any underlying factors.
• Reassurance and education about possible underlying factors and the time course of the disease.
• Substances that dilate skin blood vessels, e.g. alcohol and spicy foods, should be avoided.
• Cosmetics, cleansers and moisturizers should be avoided during treatment.
• Minor presentations, children and pregnant women should be treated with topical therapy.³ Metronidazole or erythromycin are administered in a non-greasy base. Ointments should be avoided.
• In severe forms, systemic treatment with anti-acne drugs is required. The drugs of choice are doxycycline (or tetracycline) and minocycline.
• In unresponsive and granulomatous forms, oral isotretinoin or isoniazid may be considered.
• An initial worsening of the symptoms may occur with treatment, especially if topical steroids are withdrawn. In cases of preceding long-term misuse of topical steroids, gradual steroid withdrawal with low-dose 0.1-0.5% hydrocortisone cream can be tried initially.

• Emotional complications may develop because of the nature and chronic course of the disease. Patients may have marked lifestyle restrictions due to the disfiguring facial lesions.
• Scarring may be a problem with the lupoid form of perioral dermatitis.