Dr Ian Webster
Dr Ian Webster

Perioral Dermatitis

Perioral dermatitis is a common skin eruption that occurs most commonly in young female adults. It consists of multiple, small, red bumps and pustules, especially around the mouth. You can also get exactly the same small little red bumps and pustules around the eyes and alongside the nose. For this reason, it may also be referred to as periorificial dermatitis.

The exact cause of perioral dermatitis is not known but it may be related to a disturbance of the epidermal barrier function and changes in the skin microflora.

Perioral dermatitis is often triggered by the deliberate or inadvertent use of potent topical steroid creams around the mouth. Oral steroids, nasal steroids, and inhaled steroids may also be a trigger.

In my practice, I have noticed a marked increase in the incidence of perioral dermatitis with the use of cloth and surgical face masks.

Many dermatologists, including myself, view perioral dermatitis as a variant of rosacea as the two conditions typically respond to the same therapies. In rosacea, the little red bumps and pustules tend to involve the central face as well as the cheeks.

Perioral dermatitis/rosacea is differentiated from acne vulgaris by the lack of comedones (blackheads and whiteheads) which is characteristic of acne. More severe forms of acne will have deeper pustules and cysts which can lead to scarring.

Treament of Perioral Dermatitis

Immediately stop using any harsh products such as alkaline soaps, foaming cleansers or toners, and exfoliators/scrubs. The area should be cleaned using either a Micellar water cleanser or a very mild cream cleanser for sensitive skin but only once a day, preferably at night.

If potent topical steroid creams have been used around the mouth this should be stopped immediately. However, on stopping the potent topical corticosteroid creams, perioral dermatitis could get worse before it gets better. These potent topical steroid creams should never be used again in this area as their use will cause a relapse.

Topical prescription medications would include Erythromycin, Clindamycin, Metronidazole, and Tacrolimus.

Non-prescription treatments would include products that contain Azelaic acid and flavonoid polyphenols such as Resveratrol. Apply a moisturiser that helps to restore the normal epidermal barrier function of the skin and look for ingredients like Hyaluronic acid, Niacinamide, Centella Asiatica extract, Ceramides, Cholesterol, and Free fatty acids. Browse our list of Dermatologist-recommended cleansers, moisturisers, treatments, and masks for Perioral Dermatitis.

If a person has a darker skin type they should use a high factor, broad-spectrum sunscreen with an antioxidant to prevent post-inflammatory hyperpigmentation (PIH), and preferably use a mineral brand make-up.

In more severe cases, it may be necessary to prescribe an oral Tetracycline for a period of 4-6 weeks.

Unfortunately, like rosacea, perioral dermatitis may be a chronic relapsing condition, and it is best to avoid the triggers that cause this skin condition.

Reference: NCBI Bookshelf – May 2020

Posted in LEARN / LATEST ARTICLES on August 10th, 2020.

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