Acne
Perioral Dermatitis
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Perioral Dermatitis
, Periorificial Dermatitis, Perioral Acne, Acneiform Facial Eruption
See Also
Acne Rosacea
Acne Vulgaris
Definitions
Perioral Acne
Acne
iform eruption of inflammed
Papule
s 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 Corticosteroid
s, fluoridated toothpaste,
Skin Lubricant
s and cosmetics)
Hormonal fluctuations and
Oral Contraceptive
s
Infectious agents including fusobacteria and Candida Albicans
Risk Factors
Topical Corticosteroid
s (esp. potent or fluorinated
Corticosteroid
s)
Prolonged
Corticosteroid
use on the face is the most commonly associated factor
However, lesions often initially worsen on discontinuing the
Topical Corticosteroid
s
Fluoridated
Tooth
paste
Skin Lubricant
s (esp. if containing perfumes or dyes)
Cosmetics
Oral Contraceptive
s
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
Papule
s,
Pustule
s or
Vesicle
s
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
Eczema
tous
Granulomatous Periorificial Dermatitis (known as Afro-Caribbean Childhood Eruption in black children)
Variant in pre-pubescent children
Small flesh or brown colored
Papule
s (but no
Pustule
s) in same distribution as typical Perioral Dermatitis
Management
Eliminate topical irritants and allergans
Stop
Topical Corticosteroid
s
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 Lubricant
s and other occlusive agents)
May sparingly use hypoallergenic (non-perfume, no dye), non-occlusive
Skin Lubricant
s
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)
Tetracycline
s
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
Comedolytic
s
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]
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