Perioral Dermatitis Clinical Presentation
- Author: Hans J Kammler, MD, PhD; Chief Editor: William D James, MD more...
Subjective symptoms of perioral dermatitis (POD) may consist of a sensation of stinging and burning. Itching is rare.
Often, long-term use of topical steroids for minor or even undiagnosed skin alterations precedes the development of perioral dermatitis.
Perioral dermatitis tends to be chronic.
Perioral dermatitis (POD) is limited to the skin.
Skin lesions occur as grouped follicular reddish papules, papulovesicles, and papulopustules on an erythematous base with a possible confluent aspect. The papules and pustules have primarily a perioral distribution. Other locations of involvement include the nasolabial fold and lateral portions of the lower eyelids. Vulvar involvement has been reported in young girls affected with perioral dermatitis.
In an extreme variant of the disease called granulomatous perioral dermatitis, granulomatous infiltrates have a yellowish aspect at diascopy. The lesions are confluent in a well-defined plaque delineated by the nasolabial folds and chin.
An underlying cause of the perioral dermatitis (POD) cannot be detected in all patients. The etiology of perioral dermatitis is unknown; however, long-term use of topical steroids for minor skin alterations of the face often precedes the manifestation of the disease. Note the following:
- Cosmetics: Fluorinated toothpaste[5, 6] ; skin care ointments and creams, especially those with a petrolatum or paraffin base, and the vehicle isopropyl myristate are suggested to be causative factors. In an Australian study, applying foundation in addition to moisturizer and night cream resulted in a 13-fold increased risk for perioral dermatitis. The combination of moisturizer and foundation was associated with a lesser but significantly increased risk for perioral dermatitis, whereas moisturizer alone was not associated with an increased risk. Physical sunscreens have been identified as a cause of perioral dermatitis in children.
- Physical factors: UV light, heat, and wind worsen perioral dermatitis.
- Microbiologic factors: Fusiform spirilla bacteria, Candida species, and other fungi have been cultured from lesions. Research from 2015 suggests to differentiate perioral dermatitis caused by rod-shaped bacteria (possible fusobacteria) and corticosteroid-induced rosacea.
- Miscellaneous factors: Hormonal factors are suspected because of an observed premenstrual deterioration. Oral contraceptives may be a factor.
Kihiczak GG, Cruz MA, Schwartz RA. Periorificial dermatitis in children: an update and description of a child with striking features. Int J Dermatol. 2009 Mar. 48(3):304-6. [Medline].
Baratli J, Megahed M. [Lupoid perioral dermatitis as a special form of perioral dermatitis : Review of pathogenesis and new therapeutic options.]. Hautarzt. 2013 Nov 9. [Medline].
Chen AY, Zirwas MJ. Steroid-induced rosacealike dermatitis: case report and review of the literature. Cutis. 2009 Apr. 83(4):198-204. [Medline].
Peralta L, Morais P. Perioral dermatitis -- the role of nasal steroids. Cutan Ocul Toxicol. 2012 Jun. 31(2):160-3. [Medline].
Beacham BE, Kurgansky D, Gould WM. Circumoral dermatitis and cheilitis caused by tartar control dentifrices. J Am Acad Dermatol. 1990 Jun. 22(6 Pt 1):1029-32. [Medline].
Karincaoglu Y, Bayram N, Aycan O, Esrefoglu M. The clinical importance of demodex folliculorum presenting with nonspecific facial signs and symptoms. J Dermatol. 2004 Aug. 31(8):618-26. [Medline].
Abeck D, Geisenfelder B, Brandt O. Physical sunscreens with high sun protection factor may cause perioral dermatitis in children. J Dtsch Dermatol Ges. 2009 Aug. 7(8):701-3. [Medline].
Maeda A, Ishiguro N, Kawashima M. The pathogenetic role of rod-shaped bacteria containing intracellular granules in the vellus hairs of a patient with perioral dermatitis: A comparison with perioral corticosteroid-induced rosacea. Australas J Dermatol. 2015 Apr 20. [Medline].
Antille C, Saurat JH, Lübbe J. Induction of rosaceiform dermatitis during treatment of facial inflammatory dermatoses with tacrolimus ointment. Arch Dermatol. 2004 Apr. 140(4):457-60. [Medline].
Dirschka T, Tronnier H, Folster-Holst R. Epithelial barrier function and atopic diathesis in rosacea and perioral dermatitis. Br J Dermatol. 2004 Jun. 150(6):1136-41. [Medline].
Lucas CR, Korman NJ, Gilliam AC. Granulomatous periorificial dermatitis: a variant of granulomatous rosacea in children?. J Cutan Med Surg. 2009 Mar-Apr. 13(2):115-8. [Medline].
Richey DF, Hopson B. Photodynamic therapy for perioral dermatitis. J Drugs Dermatol. 2006 Feb. 5(2 Suppl):12-6. [Medline].
Smith KW. Perioral dermatitis with histopathologic features of granulomatous rosacea: successful treatment with isotretinoin. Cutis. 1990 Nov. 46(5):413-5. [Medline].
Bribeche MR, Fedotov VP, Jillella A, Gladichev VV, Pukhalskaya DM. Topical praziquantel as a new treatment for perioral dermatitis: results of a randomized vehicle-controlled pilot study. Clin Exp Dermatol. 2014 Jun. 39 (4):448-53. [Medline].
Tempark T, Shwayder TA. Perioral dermatitis: a review of the condition with special attention to treatment options. Am J Clin Dermatol. 2014 Apr. 15 (2):101-13. [Medline].
Miller SR, Shalita AR. Topical metronidazole gel (0.75%) for the treatment of perioral dermatitis in children. J Am Acad Dermatol. 1994 Nov. 31(5 Pt 2):847-8. [Medline].
Wollenberg A, Oppel T. Scoring of skin lesions with the perioral dermatitis severity index (PODSI). Acta Derm Venereol. 2006. 86(3):251-2. [Medline].
Oppel T, Pavicic T, Kamann S, Brautigam M, Wollenberg A. Pimecrolimus cream (1%) efficacy in perioral dermatitis - results of a randomized, double-blind, vehicle-controlled study in 40 patients. J Eur Acad Dermatol Venereol. 2007 Oct. 21(9):1175-80. [Medline].
Jansen T. Perioral dermatitis successfully treated with topical adapalene. J Eur Acad Dermatol Venereol. 2002 Mar. 16(2):175-7. [Medline].
Jansen T. Azelaic acid as a new treatment for perioral dermatitis: results from an open study. Br J Dermatol. 2004 Oct. 151(4):933-4. [Medline].
Schwarz T, Kreiselmaier I, Bieber T, et al. A randomized, double-blind, vehicle-controlled study of 1% pimecrolimus cream in adult patients with perioral dermatitis. J Am Acad Dermatol. 2008 Jul. 59(1):34-40. [Medline].
Del Rosso JQ. The use of topical azelaic acid for common skin disorders other than inflammatory rosacea. Cutis. 2006 Feb. 77(2 Suppl):22-4. [Medline].
Hafeez ZH. Perioral dermatitis: an update. Int J Dermatol. 2003 Jul. 42(7):514-7. [Medline].
Katsambas AD, Nicolaidou E. Acne, perioral dermatitis, flushing, and rosacea: unapproved treatments or indications. Clin Dermatol. 2000 Mar-Apr. 18(2):171-6. [Medline].
Boeck K, Abeck D, Werfel S, Ring J. Perioral dermatitis in children--clinical presentation, pathogenesis-related factors and response to topical metronidazole. Dermatology. 1997. 195(3):235-8. [Medline].
Hengge UR, Ruzicka T, Schwartz RA, Cork MJ. Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol. 2006 Jan. 54(1):1-15; quiz 16-8. [Medline].
Hall CS, Reichenberg J. Evidence based review of perioral dermatitis therapy. G Ital Dermatol Venereol. 2010 Aug. 145(4):433-44. [Medline].