II. Definitions

  1. Perioral Acne
    1. Acneiform eruption of inflammed Papules in the region of the eyes, nose and mouth
  2. Acneiform Facial Eruption
    1. Acne-like facial dermatitis from facial Acne Vulgaris, Rosacea, Folliculitis, or Perioral Dermatitis
    2. See Differential Diagnosis below

III. Epidemiology

  1. Gender: Most common in women
  2. Age: Typically late teen to 40-50 years old
    1. But may occur in children and older adults

IV. Pathophysiology

  1. Poorly understood
  2. Associated factors
    1. Topical agents (Topical Corticosteroids, fluoridated toothpaste, Skin Lubricants and cosmetics)
    2. Hormonal fluctuations and Oral Contraceptives
    3. Infectious agents including fusobacteria and Candida Albicans

V. Risk Factors

  1. Topical Corticosteroids (esp. potent or fluorinated Corticosteroids)
    1. Prolonged Corticosteroid use on the face is the most commonly associated factor
    2. However, lesions often initially worsen on discontinuing the Topical Corticosteroids
  2. Fluoridated Toothpaste
  3. Skin Lubricants (esp. if containing perfumes or dyes)
  4. Cosmetics
  5. Oral Contraceptives

VII. Symptoms

  1. Mild stinging or burning pain may occur over involved region

VIII. Signs

  1. Characteristics
    1. Small (1-2 mm), erythematous Papules, Pustules or Vesicles
    2. Mild scale may be present
  2. Distribution
    1. Perioral region (most common)
      1. Narrow band of sparing immediately around the region of the lips
    2. Perinasal region (common)
    3. Periorbital region (common)
    4. Forehead
    5. Cheeks
    6. Chin
    7. Neck

IX. Associated Conditions: Variants

  1. Eczematous Dermatitis
    1. Mild Eczema may accompany the Perioral Dermatitis
    2. However, typical Perioral Dermatitis is not Eczematous
  2. Granulomatous Periorificial Dermatitis (known as Afro-Caribbean Childhood Eruption in black children)
    1. Variant in pre-pubescent children
    2. Small flesh or brown colored Papules (but no Pustules) in same distribution as typical Perioral Dermatitis

X. Management

  1. Eliminate topical irritants and allergans
    1. Stop Topical Corticosteroids
      1. Expect an initial Perioral Dermatitis flare
      2. May taper off the Corticosteroid, or briefly step down to Hydrocortisone 1% before stopping
    2. Limit topical agents on the face
      1. Use only hypoallergenic non-soaps on the face (e.g. Cetaphil Skin Cleanser)
    3. Stop topical agents on the face (cosmetics, Skin Lubricants and other occlusive agents)
      1. May sparingly use hypoallergenic (non-perfume, no dye), non-occlusive Skin Lubricants
    4. Once resolved or controlled, may slowly re-introduce hypoallergenic topical agents
      1. Re-introduce one product per week
  2. Topical Agents
    1. Topical Erythromycin 2% gel applied twice weekly
    2. Topical Metronidazole 0.75% gel, lotion or cream once to twice daily
    3. Topical Pimecrolimus 1% cream applied twice daily
      1. See Calcineurin Inhibitor regarding potential malignancy risk
  3. Systemic Agents (for moderate to severe, refractory Perioral Dermatitis)
    1. Tetracyclines
      1. Tetracycline 250 to 500 mg orally twice daily
      2. Doxycyline 50 to 100 mg orally twice daily (or 100 mg once daily)
    2. Erythromycin (children <8 years old and pregnant women)
      1. Adults: Erythromycin base 333 mg three times daily or 500 mg orally twice daily
  4. Other measures: Acneiform Facial Eruption
    1. Consider differential diagnosis
    2. Consider treating as Acne Vulgaris with Comedolytics

XI. Course

  1. Variable, but typically heals without scarring
  2. Some cases spontaneously resolve in months
  3. Other cases require several years of topical therapy

XII. References

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Ontology: Perioral Dermatitis (C0263449)

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)