Perioral dermatitis

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Background

  • 90% female (increasing in males)

Etiology

  • Topical or inhaled steroids
  • use of cosmetics,
  • physical (UVB, heat, wind),
  • microbiological (fusiform spirilla, candida)
  • hormonal factors (premenstrual deterioration, use of oral contraceptives)
  • GI tract abnormalities (malabsorption)
  • emotional stress.

Clinical Features

ADC 2008 335.jpg
  • papular, vesiculopapular and papulopustular lesions on erythematous base (Acneiform)
    • confluent aspect, follicular
  • location perioral, limited to skin
    • typically respects rim around and 3-5 mm under lower lip, circular

Differential Diagnosis

  • Rosacea
  • Seborrheic Dermatitis
  • Acne vulgaris
  • Facial demodicosis
  • Lupus milliaris
  • Polymorphous light reaction
  • Contact dermatitis
  • Haber syndrome
  • Granulomatous periorificial dermatitis

Oral rashes and lesions

Evaluation

  • Usually clinical

Management

  • Discontinue suspected topicals
  • Rebound reaction
    • hydrocortisone cuts down reaction violence
  • Corticosteroid dependence - psychological follow up
  • Suppression of follicular bacterial infection
    • Lipophilic tetracyclines 100-250mg/d for 3-4 months
    • no response - Isotretinoin
    • Children - oral, topical Erythromycin, Metronidazole
  • Antipruritics containing no corticosteroids

Complications

  • Disfiguring scars - emotional
  • Rebound effect, chronic course
  • Lupus-like PD - dermal infiltrate, scarring
    • Yellowish discoloration after diascopy

See Also

References

  • Ljubojević et al. "Perioral dermatitis" Acta Dermatovenerol Croat. 2008;16(2):96-100