II. Definitions
- Perioral Acne
- Acneiform Facial Eruption
- Acne-like facial dermatitis from facial Acne Vulgaris, Rosacea, Folliculitis, or Perioral Dermatitis
- See Differential Diagnosis below
III. Epidemiology
- Gender: Most common in women
- Age: Typically ages 16 to 40-50 years old
- But may occur in children and older adults
IV. Pathophysiology
- Poorly understood
- Associated factors
- Topical agents (Topical Corticosteroids, fluoridated toothpaste, Skin Lubricants and cosmetics)
- Hormonal fluctuations and Oral Contraceptives
- Infectious agents including fusobacteria and Candida Albicans
V. Risk Factors
-
Topical Corticosteroids (esp. potent or fluorinated Corticosteroids)
- Prolonged Corticosteroid use on the face is the most commonly associated factor
- However, lesions often initially worsen on discontinuing the Topical Corticosteroids
- Fluoridated Toothpaste
- Skin Lubricants (esp. if containing perfumes or dyes)
- Cosmetics
- Oral Contraceptives
VI. Differential Diagnosis: Acneiform Facial Eruption
- Acne Rosacea
- Acne Vulgaris
- Seborrheic Dermatitis
- Irritant Contact Dermatitis
- Allergic Contact Dermatitis
- Tinea Corporis
- Tinea Barbae
- Impetigo
-
Superficial Folliculitis (less common)
- Gram-Negative Folliculitis
- Eosinophilic Folliculitis (may be associated with HIV Infection)
VII. Symptoms
- Mild stinging or burning pain may occur over involved region
VIII. Signs
- Characteristics
- Distribution
- Perioral region (most common)
- Narrow band of sparing immediately around the region of the lips
- Perinasal region (common)
- Periorbital Dermatitis (common)
- See Periocular Dermatitis (Periorbital Dermatitis) as below
- Forehead
- Cheeks
- Chin
- Neck
- Perioral region (most common)
IX. Associated Conditions: Variants
- Eczematous Dermatitis
- Granulomatous Periorificial Dermatitis (known as Afro-Caribbean Childhood Eruption in black children)
- Periocular Dermatitis (Periorbital Dermatitis)
- Scaly, Red Papules and Pustules around the eye and Eyelid
- May be associated with Perioral Dermatitis or be isolated to the periocular region
- Consider differential diagnosis
X. Management
- Eliminate topical irritants and allergans
- Stop Topical Corticosteroids
- Expect an initial Perioral Dermatitis flare
- May taper off the Corticosteroid, or briefly step down to Hydrocortisone 1% before stopping
- Limit topical agents on the face
- Use only hypoallergenic non-soaps on the face (e.g. Cetaphil Skin Cleanser)
- Stop topical agents on the face (cosmetics, Skin Lubricants and other occlusive agents)
- May sparingly use hypoallergenic (non-perfume, no dye), non-occlusive Skin Lubricants
- Once resolved or controlled, may slowly re-introduce hypoallergenic topical agents
- Re-introduce one product per week
- Stop Topical Corticosteroids
- Topical Agents
- Topical Erythromycin 2% gel applied twice weekly
- Topical Metronidazole 0.75% gel, lotion or cream once to twice daily
- Topical Pimecrolimus 1% cream applied twice daily
- See Calcineurin Inhibitor regarding potential malignancy risk
- Systemic Agents (for moderate to severe, refractory Perioral Dermatitis)
- Tetracyclines
- Tetracycline 250 to 500 mg orally twice daily
- Doxycyline 50 to 100 mg orally twice daily (or 100 mg once daily)
- Erythromycin (children <8 years old and pregnant women)
- Adults: Erythromycin Base 333 mg three times daily or 500 mg orally twice daily
- Tetracyclines
- Other measures: Acneiform Facial Eruption
- Consider differential diagnosis
- Consider treating as Acne Vulgaris with Comedolytics
XI. Course
- Variable, but typically heals without scarring
- Some cases spontaneously resolve in months
- Other cases require several years of topical therapy
XII. References
- Reichenberg (2019) Perioral Dermatitis, UpToDate, accessed 6/15/2019
- (2002) Am Fam Physician 66(3):479-480 [PubMed]
- Cheung (2005) Can Fam Physician 51(4): 527–533 +PMID:15856972 [PubMed]
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Related Studies
Definition (MSH) | A papular eruption of unknown etiology that progresses to residual papular erythema and scaling usually confined to the area of the mouth, and almost exclusively occurring in young women. It may also be localized or extend to involve the eyelids and adjacent glabella area of the forehead (periocular dermatitis). (Dorland, 28th ed) |
Concepts | Disease or Syndrome (T047) |
MSH | D019557 |
ICD10 | L71.0 |
SnomedCT | 68805003, 200934000, 238751002 |
English | Dermatitides, Perioral, Dermatitis, Perioral, Perioral Dermatitides, perioral dermatitis (diagnosis), perioral dermatitis, Peri-oral dermatitis, Dermatitis perioral, Dermatitis, Perioral [Disease/Finding], dermatitis perioral, Dermatitis;perioral, Perioral dermatitis, POD - Perioral dermatitis, Perioral dermatitis (disorder), dermatitis; perioral, perioral; dermatitis, Perioral Dermatitis |
Dutch | periorale dermatitis, dermatitis perioraal, dermatitis; perioralis, perioralis; dermatitis, Dermatitis perioralis, Periorale dermatitis |
French | Dermite périorale, Dermite péri-buccale, Dermatite périorale |
German | Dermatitis, perioral, periorale Dermatitis, Dermatitis, periorale, Periorale Dermatitis |
Portuguese | Dermatite perioral, Dermatite Perioral |
Spanish | Dermatitis perioral, dermatitis perioral, dermatitis peribucal (trastorno), dermatitis peribucal, Dermatitis Perioral |
Swedish | Dermatit, perioral |
Japanese | コウイヒフエン, ステロイド酒さ, 皮膚炎-酒さ様, 皮膚炎-眼周囲, 皮膚炎-口周囲, 口周皮膚炎, 口囲皮膚炎, 口周囲皮膚炎, 酒さ様皮膚炎, 皮膚炎-口周, 皮膚炎-口囲, 眼周囲皮膚炎 |
Finnish | Suunympärysihottuma |
Russian | PERIOKULIARNYI DERMATIT, DERMATIT PERIORAL'NYI, PERIORAL'NYI DERMATIT, ДЕРМАТИТ ПЕРИОРАЛЬНЫЙ, ПЕРИОКУЛЯРНЫЙ ДЕРМАТИТ, ПЕРИОРАЛЬНЫЙ ДЕРМАТИТ |
Czech | Periorální dermatitida, dermatitida periorální, periorální dermatitida |
Korean | 입주위 피부염 |
Polish | Zapalenie skóry wokół ust |
Hungarian | szájkörüli dermatitis, Perioralis dermatitis, peri-oralis dermatitis |
Norwegian | Perioral dermatitt, Dermatitis perioralis |
Italian | Dermatite periorale |
Ontology: acneiform eruption on face (C2071259)
Concepts | Finding (T033) |
English | acneiform eruption on face, acneiform eruption on face (physical finding) |