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Perioral Dermatitis
Aka: Perioral Dermatitis, Periorificial Dermatitis, Perioral Acne, Acneiform Facial Eruption
- See Also
- Acne Rosacea
- Acne Vulgaris
- Definitions
- Perioral Acne
- Acneiform eruption of inflammed Papules in the region of the eyes, nose and mouth
- Acneiform Facial Eruption
- Acne-like facial dermatitis from facial Acne Vulgaris, Rosacea, Folliculitis, or Perioral Dermatitis
- See Differential Diagnosis below
- Epidemiology
- Gender: Most common in women
- Age: Typically late teen to 40-50 years old
- But may occur in children and older adults
- 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
- 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
- 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)
- Symptoms
- Mild stinging or burning pain may occur over involved region
- Signs
- Characteristics
- Small (1-2 mm), erythematous Papules, Pustules or Vesicles
- Mild scale may be present
- Distribution
- Perioral region (most common)
- Narrow band of sparing immediately around the region of the lips
- Perinasal region (common)
- Periorbital region (common)
- Forehead
- Cheeks
- Chin
- Neck
- Associated Conditions: Variants
- Eczematous Dermatitis
- Mild Eczema may accompany the Perioral Dermatitis
- However, typical Perioral Dermatitis is not Eczematous
- Granulomatous Periorificial Dermatitis (known as Afro-Caribbean Childhood Eruption in black children)
- Variant in pre-pubescent children
- Small flesh or brown colored Papules (but no Pustules) in same distribution as typical Perioral Dermatitis
- 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
- 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
- Other measures: Acneiform Facial Eruption
- Consider differential diagnosis
- Consider treating as Acne Vulgaris with Comedolytics
- Course
- Variable, but typically heals without scarring
- Some cases spontaneously resolve in months
- Other cases require several years of topical therapy
- 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]