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 a13-fold increased risk for perioral dermatitis.