Perioral dermatitis: Difference between revisions
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===Etiology=== | ===Etiology=== | ||
*Topical or inhaled | *[[topical steroids|Topical]] or [[inhaled corticosteroid]]s | ||
*use of cosmetics, | *use of cosmetics, | ||
*physical (UVB, heat, wind), | *physical (UVB, heat, wind), | ||
*microbiological (fusiform spirilla, candida) | *microbiological (fusiform spirilla, [[candida]]) | ||
*hormonal factors (premenstrual deterioration, use of oral contraceptives) | *hormonal factors (premenstrual deterioration, use of oral contraceptives) | ||
*GI tract abnormalities (malabsorption) | *GI tract abnormalities (malabsorption) | ||
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==Clinical Features== | ==Clinical Features== | ||
[[File:ADC 2008 335.jpg|thumb]] | [[File:ADC 2008 335.jpg|thumb]] | ||
*papular, vesiculopapular and papulopustular lesions on erythematous base (Acneiform) | *papular, vesiculopapular and papulopustular [[rash|lesions]] on erythematous base (Acneiform) | ||
**confluent aspect, follicular | **confluent aspect, follicular | ||
*location perioral, limited to skin | *location perioral, limited to skin | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Rosacea | *Rosacea | ||
*Seborrheic | *[[Seborrheic dermatitis]] | ||
*Acne vulgaris | *Acne vulgaris | ||
*Facial demodicosis | *Facial demodicosis | ||
*Lupus milliaris | *[[Lupus]] milliaris | ||
*Polymorphous light reaction | *Polymorphous light reaction | ||
*Contact dermatitis | *[[Contact dermatitis]] | ||
*Haber syndrome | *Haber syndrome | ||
*Granulomatous periorificial dermatitis | *Granulomatous periorificial dermatitis | ||
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*Discontinue suspected topicals | *Discontinue suspected topicals | ||
*Rebound reaction | *Rebound reaction | ||
**hydrocortisone cuts down reaction violence | **[[hydrocortisone]] cuts down reaction violence | ||
*Corticosteroid dependence - psychological follow up | *[[Corticosteroid]] dependence - psychological follow up | ||
*Suppression of follicular bacterial infection | *Suppression of follicular bacterial infection | ||
**Lipophilic tetracyclines 100-250mg/d for 3-4 months | **Lipophilic [[tetracyclines]] 100-250mg/d for 3-4 months | ||
**no response - Isotretinoin | **no response - Isotretinoin | ||
**Children - oral, topical | **Children - oral, topical [[erythromycin]], [[metronidazole]] | ||
*Antipruritics containing no corticosteroids | *Antipruritics containing no corticosteroids | ||
Revision as of 01:06, 28 September 2019
Background
- 90% female (increasing in males)
Etiology
- Topical or inhaled corticosteroids
- 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
- 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
- Angioedema
- Aphthous stomatitis
- Herpes gingivostomatitis
- Herpes labialis
- Measles (Koplik's spots)
- Perioral dermatitis
- Oral thrush
- Steven Johnson syndrome
- Streptococcal pharyngitis
- Tongue diagnoses
- Vincent's angina
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