Perioral Dermatitis

Perioral dermatitis, often referred to as periorificial dermatitis, is a chronic inflammatory skin eruption that most commonly occurs around the mouth but can also occur around the eyes, nostrils, and genitals. This rash is not contagious and usually affects lighter-skinned women between the ages of 20 and 45.

Cause

The etiology of perioral dermatitis is not completely understood. This is often associated with exposure to an allergen or irritant. Risk factors include oral and topical steroid use, cosmetic use, and irritants such as toothpaste. Epidermal barrier disruption, hormonal changes, and atopic disease have also been associated with increased risk.

Clinical Features

This rash appears as small skin-colored to red papules and pustules with a dry, erythematous base surrounding the affected orifice. This rash is occasionally mildly pruritic and associated with increased skin sensitivity.

Complications

Complications can include increased risk of secondary bacterial or fungal infections. Severe rebound flare may also occur after abrupt cessation of topical steroids.

Diagnosis

Diagnosis is often made clinically based on history and appearance. Skin scraping or patch testing can be used to rule out fungal infections or allergic dermatitis. If the diagnosis is uncertain, a biopsy can be performed.

Treatment

Perioral dermatitis is often self-limiting but in persistent cases dermatologic treatment may be required. When treating perioral dermatitis, it is important to switch to mild, fragrance-free skin care products and discontinue all topical steroids. Topical steroids provide temporary relief but will ultimately cause worsening over time. Treatments include oral tetracyclines, topical antibiotics, and calcineurin inhibitors. Oral isotretinoin can also be utilized in severe, refractory cases.

Differential Diagnosis

This condition can resemble acne, rosacea, seborrheic dermatitis, contact dermatitis, and impetigo.

Citation: "Periorificial Dermatitis." (n.d.). DermNet NZ. Retrieved from https://dermnetnz.org/topics/periorificial-dermatitis.

"Perioral Dermatitis: Overview." (n.d.). American Academy of Dermatology. Retrieved from https://www.aad.org/public/diseases/a-z/perioral-dermatitis.

Written by Alexandra Jewell, PA

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