Perioral Dermatitis - Causes, Symptoms, and Treatment

What Is Perioral Dermatitis? Who Gets It?

Perioral dermatitis is an inflammatory red rash involving the skin around the mouth. Sometimes the rash may spread up to the nose or even the eyes. The condition is called periorificial dermatitis. The skin appears scaly, dry, and flaky with swollen, inflamed bumps. The bumps may be fluid-filled, so there may be a transparent fluid oozing from the bumps. The condition is not contagious and cannot pass from one to another. The condition most commonly happens in young women (between 20 and 45 years old), but it can also affect men. It can affect anyone of any age, race, or ethnicity. In addition, it may occur in children of any age. Perioral dermatitis is not contagious and cannot transmit from one person to another.

What Are the Causes of Perioral Dermatitis?

The actual cause of perioral dermatitis is not known, but experts believe the following can be the possible causes of perioral dermatitis:

• Topical corticosteroids may be prescribed to treat another condition, including steroid creams or inhaled prescription steroid sprays.

• Personal care products like moisturizers and heavy face creams may worsen this condition.

• Using fluoridated toothpaste.

• Chewing gum and dental fillings.

• Hormonal changes (or oral contraceptives).

• Immune system problem.

• Epidermal barrier dysfunction.

• Altered cutaneous microflora.

• Bacteria – follicular fusiform.

• Candida albicans.

• Demodex mites.

Who Is at More Risk for Perioral Dermatitis?

Perioral dermatitis is most often seen in:

• Young women (aged between 25 and 45).

• People who use topical corticosteroid medications, moisturizers, and face creams.

• People who have a history of allergies.

• People who have hormonal imbalances.

However, children and men can also develop perioral dermatitis.

What Are the Symptoms of Perioral Dermatitis?

Perioral dermatitis may have the following symptoms:

• Scaly, dry, or flaky red rash that circles the mouth.

• Inflamed bumps called papules around the mouth.

• Clear fluid-filled bumps called vesicles or white fluid-filled bumps or pustules.

• Itching or burning sensation from the rash.

• Although it usually involves the mouth, perioral dermatitis can also affect the eyes, nose, genitals, scalp, ears, neck, extremities, and trunk.

• Rare cases of granulomatous periorificial dermatitis may present with conjunctivitis (pink eye) when they have perioral dermatitis.

• Lupoid perioral dermatitis, a more severe variant form of perioral dermatitis, may present with dense groupings of red-brown papules.

How Is Perioral Dermatitis Diagnosed?

A dermatologist usually diagnoses perioral dermatitis with a visual examination of the skin and medical history. The dermatologist may recommend a skin biopsy to distinguish perioral dermatitis from other dermatitis types, like contact and atopic dermatitis. The dermatologist may also perform a skin culture test if a bacterial component is suspected. In addition, the doctor may consider scraping and potassium hydroxide (KOH) prep for Candida albicans. For severe cases, diascopy can be performed by a dermatologist.

How Is Perioral Dermatitis Treated?

Several available medical treatments can help manage perioral dermatitis symptoms. Perioral dermatitis responds to the available treatments, but the condition can be chronic and recurrent.

The healthcare professional may recommend one or more of the following medications:

• The first line of treatment includes Erythromycin gel, Clindamycin lotion, Metronidazole cream, Azelaic acid gel, and topical sulfur preparations.

• Topical calcineurin inhibitors like Tacrolimus ointment or Pimecrolimus cream may help improve the lesions.

• Topical Adapalene can also be effective.

• Oral antibiotics such as Tetracycline, Doxycycline, Minocycline, and oral low-dose isotretinoin also improve rapidly.

• Photodynamic therapy with a 5-aminolevulinic acid may also provide the benefit.

• Consult an ophthalmologist if symptoms of conjunctivitis, such as burning, itching, or tearing, are present.

What Is the Outlook for People With Perioral Dermatitis?

Perioral dermatitis persists for days, weeks, months, or even years. For some people, the rash may resolve entirely after discontinuation of a trigger, including topical steroids and skincare products. However, perioral dermatitis can be chronic and recurrent and require long-term treatment.

What Is the Prevention for Perioral Dermatitis?

While it may not be possible to prevent all cases, these steps may help alleviate perioral dermatitis or prevent it from worsening.

• Avoid using topical corticosteroids unless specifically directed by the dermatologist. Even though topical corticosteroids may provide temporary relief, the rash may flare up and worsen when they are discontinued.

• Avoid using heavy cosmetic products or skin creams. Instead, consult a dermatologist on which moisturizers are acceptable to use.

• Switch to gentle cleansers and moisturizers. Ask a dermatologist for recommendations that would best suit the skin.

• Always protect the skin by limiting the time the skin comes into contact with the elements. The sun’s harmful ultraviolet (UV) rays, heat, and wind may aggravate perioral dermatitis.

• Once the rash clears, do not start using steroids, face creams, or other products that possibly cause it.

• Wash the rash with warm water. Avoid using soap until it is gone.

• Listen carefully to the healthcare provider’s instructions to prevent perioral dermatitis from worsening.

• Follow the treatment plan and be gentle in taking care of your skin.

What Are the Complications of Perioral Dermatitis?

Perioral dermatitis often results in:

• Scarring may occur in some severe cases, especially in the lupoid form of this condition.

• Skin irritation or allergic reaction.

• Skin dryness, burning, itching, or hypopigmentation.

• Emotional distress, such as anger, sadness, or frustration due to the chronicity of the illness.

• Poor quality of life, social isolation, and low self-esteem due to disfiguring lesions on the face.

Conclusion

Perioral dermatitis is the most common of all types of dermatitis. It is often distressing to have a rash. Fortunately, a dermatologist can manage most people with perioral dermatitis effectively and safely. Although topical steroid use is considered the most likely cause, there are also a variety of other possible causes that may lead to perioral dermatitis. Therefore, working with a healthcare provider is critical to determining an effective treatment plan. Follow the healthcare provider’s instructions carefully.