Perioral dermatitis

Published on 19/03/2015 by admin

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Perioral dermatitis

Antonios Kanelleas and John Berth-Jones

Evidence Levels:  A Double-blind study  B Clinical trial ≥ 20 subjects  C Clinical trial < 20 subjects  D Series ≥ 5 subjects  E Anecdotal case reports

image

Perioral dermatitis is a persistent erythematous eruption of inflammatory papules (and sometimes pustules) on the chin, perioral areas, and nasolabial folds, characteristically sparing the skin immediately adjacent to the vermilion border. The main symptoms include pruritus, burning sensation and soreness. It is usually seen in young women, but also occurs in childhood. The etiology is unknown, however the development of perioral dermatitis is frequently preceded by intentional or inadvertent application of potent topical corticosteroids to the facial skin. The use of steroid inhalers may also induce perioral dermatitis. A similar eruption involving the eyelids and periorbital skin has been termed periocular dermatitis. The granulomatous subset of perioral dermatitis, which is seen in prepubertal children, presents with small flesh-colored or yellow-brown papules.

The suggested relationship of perioral dermatitis with infectious agents and infestations such as Candida spp, Demodex folliculorum and fusiform bacteria has not been confirmed. However, a high prevalence of atopy has been found amongst patients with perioral dermatitis.

Although sometimes described as a variant of rosacea, perioral dermatitis is distinguished from this disease by its distribution, by the relatively monomorphic appearance of the lesions, by the absence of flushing and telangiectasia, and by its tendency to occur in younger patients. Differential diagnoses also include contact dermatitis, which does not usually spare the lip margins.

First-line treatment

imageWithdrawal of topical corticoids B
imageOral tetracyclines B

Second-line treatments

imageTopical pimecrolimus A
imageTopical tetracycline B
imageTopical erythromycin B
imageOral erythromycin E
imageTopical metronidazole C
imageTopical azelaic acid D
imageOral isotretinoin E
imageTopical adapalene E
imagePhotodynamic therapy B

[/level-membership-for-dermatology-category][not-level-membership-for-dermatology-category]

Perioral dermatitis

Antonios Kanelleas and John Berth-Jones

Evidence Levels:  A Double-blind study  B Clinical trial ≥ 20 subjects  C Clinical trial < 20 subjects  D Series ≥ 5 subjects  E Anecdotal case reports

image

Perioral dermatitis is a persistent erythematous eruption of inflammatory papules (and sometimes pustules) on the chin, perioral areas, and nasolabial folds, characteristically sparing the skin immediately adjacent to the vermilion border. The main symptoms include pruritus, burning sensation and soreness. It is usually seen in young women, but also occurs in childhood. The etiology is unknown, however the development of perioral dermatitis is frequently preceded by intentional or inadvertent application of potent topical corticosteroids to the facial skin. The use of steroid inhalers may also induce perioral dermatitis. A similar eruption involving the eyelids and periorbital skin has been termed periocular dermatitis. The granulomatous subset of perioral dermatitis, which is seen in prepubertal children, presents with small flesh-colored or yellow-brown papules.

The suggested relationship of perioral dermatitis with infectious agents and infestations such as Candida spp, Demodex folliculorum and fusiform bacteria has not been confirmed. However, a high prevalence of atopy has been found amongst patients with perioral dermatitis.

Although sometimes described as a variant of rosacea, perioral dermatitis is distinguished from this disease by its distribution, by the relatively monomorphic appearance of the lesions, by the absence of flushing and telangiectasia, and by its tendency to occur in younger patients. Differential diagnoses also include contact dermatitis, which does not usually spare the lip margins.

First-line treatment

imageWithdrawal of topical corticoids B
imageOral tetracyclines B