eMedicine Specialties > Dermatology > Diseases of the Adnexa

Perioral Dermatitis: Differential Diagnoses & Workup

Author: Hans J Kammler, MD, PhD, Head of Unit for Dermatology, ENT, Ophthalmology, and Respiratory Diseases, German Federal Institute for Drugs and Medical Devices (BfArM)
Contributor Information and Disclosures

Updated: Oct 23, 2009

Differential Diagnoses

Acne Vulgaris
Contact Dermatitis, Allergic
Contact Dermatitis, Irritant
Lupus Miliaris Disseminatus Faciei
Rosacea

Other Problems to Be Considered

Facial demodicosis (infestation with Demodex follicularis) clinically resembles perioral dermatitis (POD) and should be excluded, especially when anti-inflammatory therapies fail.6

Patients who are prone to acne or rosacea may experience worsening while undergoing topical immunomodulating therapy (eg, with tacrolimus ointment).7

Haber syndrome, or familial rosacealike dermatosis with intra-epidermal epitheliomas, keratotic plaques, and scars, is a rare genodermatosis that begins in childhood.

Granulomatous periorificial dermatitis manifests most commonly in prepubertal children as yellow-brown papules limited to the perioral, perinasal, and periocular regions. The condition is self-limited and is not associated with systemic involvement.8

Workup

Laboratory Studies

The diagnosis is made clinically. No laboratory abnormalities can be expected.

Other Tests

Clinical criteria, prick tests, and specific IgE testing against a mixture of aeroallergens has been used to test for skin barrier disfunction. In a German study,9 Perioral dermatitis patients experienced significantly increased transepidermal water loss compared with rosacea patients and a control group, which indicated a skin barrier function disorder. This type of testing is not routinely used.

Histologic Findings

Histologic findings are similar to those of rosacea, but the signs of actinic skin damage are generally less intense and vary according to the patient's age. Thus, a lymphohistiocytic infiltrate with perifollicular localization can be expected in all stages. A marked granulomatous inflammation and, occasionally, perifollicular abscesses may be present when pustules and papules are the dominant clinical findings. Caseating granulomata are characteristic features of granulomatous perioral dermatitis.

More on Perioral Dermatitis

Overview: Perioral Dermatitis
Differential Diagnoses & Workup: Perioral Dermatitis
Treatment & Medication: Perioral Dermatitis
Follow-up: Perioral Dermatitis
References
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References

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

  3. 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].

  4. Karincaoglu Y, Bayram N, Aycan O, Esrefoglu M. The clinical importance of demodex folliculorum presenting with nonspecific facial signs and symptoms. J Dermatol. Aug 2004;31(8):618-26. [Medline].

  5. Abeck D, Geisenfelder B, Brandt O. Physical sunscreens with high sun protection factor may cause perioral dermatitis in children. J Dtsch Dermatol Ges. Aug 2009;7(8):701-3. [Medline].

  6. Antille C, Saurat JH, Lübbe J. Induction of rosaceiform dermatitis during treatment of facial inflammatory dermatoses with tacrolimus ointment. Arch Dermatol. Apr 2004;140(4):457-60. [Medline].

  7. 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].

  8. 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].

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

  10. Smith KW. Perioral dermatitis with histopathologic features of granulomatous rosacea: successful treatment with isotretinoin. Cutis. Nov 1990;46(5):413-5. [Medline].

  11. 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].

  12. 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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  26. Malik R, Quirk CJ. Topical applications and perioral dermatitis. Australas J Dermatol. Feb 2000;41(1):34-8. [Medline].

  27. Nguyen V, Eichenfield LF. Periorificial dermatitis in children and adolescents. J Am Acad Dermatol. Nov 2006;55(5):781-5. [Medline].

  28. Takiwaki H, Tsuda H, Arase S, Takeichi H. Differences between intrafollicular microorganism profiles in perioral and seborrhoeic dermatitis. Clin Exp Dermatol. Sep 2003;28(5):531-4. [Medline].

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  30. Urbatsch AJ, Frieden I, Williams ML, Elewski BE, Mancini AJ, Paller AS. Extrafacial and generalized granulomatous periorificial dermatitis. Arch Dermatol. Oct 2002;138(10):1354-8. [Medline].

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Further Reading

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Keywords

perioral dermatitis, POD, rosacealike dermatitis, periorificial dermatitis, light-sensitive seborrheid, chronic papulopustular facial dermatitis, papulopustular facial dermatitis, granulomatous perioral dermatitis, lupuslike perioral dermatitis

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Contributor Information and Disclosures

Author

Hans J Kammler, MD, PhD, Head of Unit for Dermatology, ENT, Ophthalmology, and Respiratory Diseases, German Federal Institute for Drugs and Medical Devices (BfArM)
Disclosure: Nothing to disclose.

Medical Editor

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 Ownership interest Consulting

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University 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.

Managing Editor

Jeffrey Meffert, MD, Assistant Clinical Professor of Dermatology, University of Texas Health Science Center-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.

CME Editor

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.

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