Perioral Dermatitis Clinical Presentation

  • Author: Hans J Kammler, MD, PhD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Mar 9, 2011
 

History

Subjective symptoms of perioral dermatitis (POD) consist of a sensation of burning and tension. Itching is rare.

Often, an uncritical use of topical steroids for minor or even undiagnosed skin alterations precedes the development of perioral dermatitis.

Perioral dermatitis tends to be chronic. Patients may have marked lifestyle restrictions due to the disfiguring facial lesions.

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Physical

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 mainly perioral locations. Besides the perioral area, the predominant locations of perioral dermatitis lesions are nasolabial fold and lateral portions of the lower eyelids.

In an extreme variant of the disease called lupuslike perioral dermatitis granulomatous infiltrates have a yellowish aspect at diascopy.

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Causes

An underlying cause of the perioral dermatitis (POD) cannot be detected in all patients. The etiology of perioral dermatitis is unknown; however, the uncritical use of topical steroids for minor skin alterations of the face often precedes the manifestation of the disease. Note the following:

  • Drugs: Many patients abuse topical steroid preparations.[3] No clear correlation exists between the risk of perioral dermatitis and strength of the steroid or the duration of the abuse.
  • Cosmetics: Fluorinated toothpaste[4, 5] ; 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. Recently, physical sunscreens have been identified as a cause of perioral dermatitis in children.[6]
  • 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. Their presence has no clear clinical relevance. In addition, candidiasis is suggested to provoke perioral dermatitis.
  • Miscellaneous factors: Hormonal factors are suspected because of an observed premenstrual deterioration. Oral contraceptives may be a factor. Gastrointestinal disturbances, such as malabsorption, have been considered as well.
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Contributor Information and Disclosures
Author

Hans J Kammler, MD, PhD  Head of Licensing Unit for Dermatology, ENT, Ophthalmology, and Respiratory System, German Federal Institute for Drugs and Medical Devices (BfArM)

Disclosure: Nothing to disclose.

Specialty Editor Board

James Fulton Jr, MD, PhD  Center for Cosmetic Dermatology; Consultant, Vivant Pharmaceuticals, LLC

James Fulton Jr, MD, PhD is a member of the following medical societies: American Academy of Cosmetic Surgery, American Academy of Dermatology, American Society for Laser Medicine and Surgery, Dermatology Foundation, International Society of Cosmetic and Laser Surgeons, and Skin Cancer Foundation

Disclosure: Vivant Pharmaceuticals Grant/research funds Consulting

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD  Assistant Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

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  2. Guarneri F, Marini H. An unusual case of perioral dermatitis: possible pathogenic role of neurogenic inflammation. J Eur Acad Dermatol Venereol. Mar 2007;21(3):410-2. [Medline].

  3. Chen AY, Zirwas MJ. Steroid-induced rosacealike dermatitis: case report and review of the literature. Cutis. Apr 2009;83(4):198-204. [Medline].

  4. Beacham BE, Kurgansky D, Gould WM. Circumoral dermatitis and cheilitis caused by tartar control dentifrices. J Am Acad Dermatol. Jun 1990;22(6 Pt 1):1029-32. [Medline].

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  8. Dirschka T, Tronnier H, Folster-Holst R. Epithelial barrier function and atopic diathesis in rosacea and perioral dermatitis. Br J Dermatol. Jun 2004;150(6):1136-41. [Medline].

  9. Lucas CR, Korman NJ, Gilliam AC. Granulomatous periorificial dermatitis: a variant of granulomatous rosacea in children?. J Cutan Med Surg. Mar-Apr 2009;13(2):115-8. [Medline].

  10. Richey DF, Hopson B. Photodynamic therapy for perioral dermatitis. J Drugs Dermatol. Feb 2006;5(2 Suppl):12-6. [Medline].

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  12. 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].

  13. Miller SR, Shalita AR. Topical metronidazole gel (0.75%) for the treatment of perioral dermatitis in children. J Am Acad Dermatol. Nov 1994;31(5 Pt 2):847-8. [Medline].

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  15. 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. Oct 2007;21(9):1175-80. [Medline].

  16. Jansen T. Perioral dermatitis successfully treated with topical adapalene. J Eur Acad Dermatol Venereol. Mar 2002;16(2):175-7. [Medline].

  17. Jansen T. Azelaic acid as a new treatment for perioral dermatitis: results from an open study. Br J Dermatol. Oct 2004;151(4):933-4. [Medline].

  18. 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. Jul 2008;59(1):34-40. [Medline].

  19. Del Rosso JQ. The use of topical azelaic acid for common skin disorders other than inflammatory rosacea. Cutis. Feb 2006;77(2 Suppl):22-4. [Medline].

  20. Hafeez ZH. Perioral dermatitis: an update. Int J Dermatol. Jul 2003;42(7):514-7. [Medline].

  21. Katsambas AD, Nicolaidou E. Acne, perioral dermatitis, flushing, and rosacea: unapproved treatments or indications. Clin Dermatol. Mar-Apr 2000;18(2):171-6. [Medline].

  22. Hengge UR, Ruzicka T, Schwartz RA, Cork MJ. Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol. Jan 2006;54(1):1-15; quiz 16-8. [Medline].

  23. Hall CS, Reichenberg J. Evidence based review of perioral dermatitis therapy. G Ital Dermatol Venereol. Aug 2010;145(4):433-44. [Medline].

 
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