Perioral Dermatitis Information

Perioral dermatitis is a distinctive eruption that occurs in young

women and resembles acne. The eruption is confined to the nasolabial

folds and spares a clear zone around the vermilion border. Papules and

pustules on an erythematous base is the most common presentation. There

are varying degrees of involvement. This patient has involvement of the

entire perioral area. This patient presents with just a few papules.

This limited eruption is the most common presentation. Scaling is seen

in some cases. Scaling may occur as part of the disease or be induced

by drying and irritating topical treatment. The chin is the most

sensitive part of the face and does not tolerate drying therapy as well

as the forehead and cheeks. Topical preparations such as benzoyl

peroxide, tretinoin, and alcohol-based antibiotic lotions aggravate the

eruption.

Pustules on the cheeks adjacent to the nostrils are highly

characteristic. Pustules next to the nose are sometimes the only

manifestation of the disease. Pustules and papules may also be seen

lateral to the eyes and sometimes this is the only manifestation of the

disease. Patients with lateral eye involvement think they have acne,

rosacea or contact dermatitis.

The duration of perioral dermatitis is unpredictable. Some patients

respond to oral antibiotics and never have another episode. Others have recurrent disease for years.

The pathogenesis is unknown. Prolonged use of steroid creams was

thought to be the primary cause when this entity was described more

than 30 years ago. This patient was treated with a moderately strong

topical steroid. The eruption cleared but flared with intense erythema

each time she stopped treatment. This patient used a moderately strong steroid intermittently for months. She experienced intense flares with papules and pustules each time she attempted to stop treatment.

Most women with perioral dermatitis have not used topical steroids.

Occlusive topical preparations may cause the eruption. Application of

foundation, in addition to moisturizer and night creams resulted in a

13-fold increased risk for perioral dermatitis.