Perioral Dermatitis

What Is Perioral Dermatitis?

Perioral dermatitis is a common facial rash consisting of small inflamed papules (bumps) and sometimes tiny vesicles (water filled blisters) or pus spots, which are often clustered around your mouth, base of your nose and your chin. There may be some background redness on your chin and upper lip, especially if you have used steroid creams. You may sometimes feel an itchy or stinging sensation.

You won’t see comedones (whiteheads and blackheads), cysts (boil-like lesions), or scarring as you would if you have acne, nor will you see the typical flushing of rosacea.

Who Gets Perioral Dermatitis?

Women primarily get perioral dermatitis. Occasionally men will get it, most often on their eyelids.

Where Is It Found?

You will usually see it around your mouth, the base of your nose and sometimes on your eyelids. It does not extend to the lip line.

When Does It Occur?

People can get this any time between their mid-teens and menopause, but it occurs most often to people in their 20’s. Although not always recognized, it is seen quite frequently in children. It usually lasts for months, if not years (up to 2-3 years) and may recur.

What Causes Perioral Dermatitis?

The cause is not known. Steroid creams can certainly produce, as well as aggravate this condition. There have been reports about toothpastes causing this, especially the anti-tartar and fluorinated types. No infectious agents have been found to be responsible. Hormones may play a role. Cosmetic products and moisturizers in particular may worsen the rash. Some experts believe perioral dermatitis may be related to rosacea.

What Other Skin Conditions Look Like Perioral Dermatitis?

Seborrheic dermatitis - usually seen as redness and scaling around the alsa nasa (the junction between the nose and lip, and around the side of the nose)
Atopic eczema - usually this is more itchy than acne and may involve the rest of the face and often the hands
Rosacea - usually seen on the cheeks, gives flushing of the skin and broken blood vessels are usually present
Contact dermatitis – this should be considered in all chronic, inflamed and itchy rashes where there is not a clear diagnosis
Steroid acne – usually this is seen on the face, but most commonly steroids produce a rosacea, systemic steroids can cause acne on the trunk and the lesions are monomorphous (all of the lesions have the same appearance)

What Can I Do About My Perioral Dermatitis?

1) Self help:

Avoid all but the weakest topical steroids on your face, they may have to be tapered in strength, if you use them for a long time, this would best be done by a dermatologist
Minimize the use of moisturizers, cosmetics should be oil-free or water based
Cover-ups can be used, but this may slow down the response of your treatment

2) Medical treatment:

Understanding your treatment options:

Topical therapy:

May occasionally work, but experience shows that oral antibiotics are most often required
Topical therapy (creams and lotions) includes Metronidazole cream, gel or lotion, which should be applied twice a day, you may not see any results for 2-3 months

Oral therapy (pills and capsules):

If you get adequate treatment, your chances of having it recur are low. Most perioral dermatitis sufferers will see improvement after 4-6 weeks, but some need to take it for longer periods. Oral therapy includes oral antibiotics such as:

Minocycline 50-100 mg twice a day until clear, which is usually 1-2 months, though some will continue at a lower dose for an additional month
Tetracycline 500 mg twice daily for 6-12 weeks
Doxycycline 100 mg twice daily for 6-12 weeks

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