Published on 19/03/2015 by admin
Filed under Dermatology
Last modified 19/03/2015
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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
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.
Many cases are associated with the use of potent topical corticosteroids, and withdrawal of this medication is the most important measure in this group. Any cosmetic products applied on the area should also be discontinued. Patients must be warned that the condition may initially flare after this maneuvre. If the flare proves intolerable, initial use of a less potent topical corticoid can often be helpful. Systemic tetracyclines are also frequently employed, and a range of other modalities are used less frequently. In most cases there will be a permanent remission, but relapses may rarely occur. In case of treatment failure, contact dermatitis should be excluded by patch testing.
No investigation is routinely required
Guin JD. J Am Acad Dermatol 1981; 4: 417–22.
Perioral dermatitis developed following the use of topical hydrocortisone.
Treatment of Skin Disease Comprehensive Therapeutic Strategies 4e
Withdrawal of topical corticoids
Oral tetracyclines
