eMedicine Specialties > Dermatology > Diseases of the Adnexa
Perioral Dermatitis
Updated: Oct 23, 2009
Introduction
Background
Perioral dermatitis (POD) is a chronic papulopustular and eczematous facial dermatitis. It mostly occurs in women, although a distinct papular variant occurs in children. The clinical and histologic features of the perioral dermatitis lesions resemble those of rosacea. Patients require systemic and/or topical treatment, an evaluation of the underlying factors, and reassurance.
Pathophysiology
The etiology of perioral dermatitis (POD) is unknown; however, the uncritical use of topical steroids for minor skin alterations of the face often precedes the manifestation of perioral dermatitis. Neurogenic inflammation has been proposed as a pathogenic mechanism.1 Perioral dermatitis is limited to the skin.
Frequency
United States
The incidence of perioral dermatitis is estimated to be 0.5-1% in industrialized countries, independent of geographic factors.
International
The incidence of perioral dermatitis seems to be lower in less developed countries, but no statistics are available.
Mortality/Morbidity
Perioral dermatitis is limited to the skin and is not life threatening. Emotional complications may develop because of the nature and chronic course of the disease (see Complications).
Sex
- Perioral dermatitis predominantly affects women, who account for an estimated 90% of the cases.
- The number of male patients is assumed to be increasing because of changes in their cosmetic habits.
Age
- Perioral dermatitis can occur in children, but it is seldom diagnosed.
- The vast majority of patients are women aged 20-45 years.
Clinical
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.
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.
- The predominant locations of perioral dermatitis lesions are the perioral area, 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.
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.
- Drugs: Many patients abuse topical steroid preparations.2 No clear correlation exists between the risk of perioral dermatitis and strength of the steroid or the duration of the abuse.
- Cosmetics: Fluorinated toothpaste3,4 ; 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.5
- 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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Overview: Perioral Dermatitis |
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| References |
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References
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Further Reading
Keywords
perioral dermatitis, POD, rosacealike dermatitis, periorificial dermatitis, light-sensitive seborrheid, chronic papulopustular facial dermatitis, papulopustular facial dermatitis, granulomatous perioral dermatitis, lupuslike perioral dermatitis
Overview: Perioral Dermatitis