Perioral Dermatits

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.

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 steroids.

The exact cause of periorificial is not understood. Unlike seborrhoeicdermatitis, which can affect similar areas of the face, malassezia yeasts are not involved in periorificial dermatitis. Periorificial dermatitis may be induced by:

  • Topical steroids, whether applied deliberately to facial skin or inadvertently
  • Nasal steroids, steroid inhalers, and oral steroids
  • Cosmetic creams, make-ups and sunscreens
  • Fluorinated toothpaste
  • Neglecting to wash the face
  • Hormonal changes and/or oral contraceptives

Periorificial dermatitis responds well to treatment, although it may take several weeks before there is noticeable improvement.

The characteristics of facial periorificial dermatitis are:

  • Unilateral or bilateral eruption on chin, upper lip and eyelids in perioral, perinasal and periocular distribution
  • Sparing of the skin bordering the lips (which then appears pale), eyelids, nostrils
  • Clusters of 1–2 mm erythematous papules or papulopustules
  • Dry and flaky skin surface
  • Burning irritation

Complications 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.

General measures

Discontinue applying all face creams including topical steroids, cosmetics and sunscreens (zero therapy).Consider a slower withdrawal from topical steroid/face creams if there is a severe flare after steroid cessation. Temporarily, replace it by a less potent or less occlusive cream or apply it less and less frequently until it is no longer required.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.Choose a liquid or gel sunscreen.

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