Perioral Dermatitis

Excerpt

Perioral dermatitis is a benign eruption that occurs most commonly in young, female adults, consisting of small inflammatory papules and pustules or pink, scaly patches around the mouth. Although the perioral region is the most common distribution area, this disease can also affect the periocular and paranasal skin (see Image. Perioral Dermatitis). For this reason, this dermatologic phenomenon is often referred to as periorificial dermatitis.

A strong association exists between perioral dermatitis and topical corticosteroid use, particularly on the face. Initially responsive to steroids, the condition often worsens with withdrawal, potentially leading to chronic, recurrent disease or a granulomatous variant. Other potential triggers include inhaled or nasal corticosteroids, fluorinated toothpaste, chewing gum, dental materials, cosmetics, sunscreens, facemask use, and improper CPAP therapy. Hormonal factors may also play a role.

Diagnosis of perioral dermatitis is typically clinical, but biopsy or additional testing may be warranted in atypical cases. Despite existing guidelines, clinicians often misdiagnose perioral dermatitis and inappropriately prescribe topical corticosteroids, which worsen the condition over time. Therefore, recognizing steroid-induced flares is essential to reduce iatrogenic harm and ensure effective management.

Topical steroid use on the face can trigger perioral dermatitis, and therefore, a primary recommendation for treatment is the discontinuation of steroid application by the patient. However, Abrupt cessation of corticosteroids can cause rebound flaring; therefore, a gradual taper may be necessary. Other treatment approaches include topical metronidazole, topical calcineurin inhibitors, and oral tetracycline antibiotics. While treatment is generally effective, perioral dermatitis can be persistent or recurrent, requiring long-term management strategies tailored to the individual.