eMedicine Specialties > Dermatology > Diseases of the Adnexa

Perioral Dermatitis

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)
Contributor Information and Disclosures

Updated: Apr 26, 2010

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.1 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.2 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. 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.

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.3 No clear correlation exists between the risk of perioral dermatitis and strength of the steroid or the duration of the abuse.
  • Cosmetics: Fluorinated toothpaste4,5 ; 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.

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. 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].

  5. 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].

  6. 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].

  7. 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].

  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].

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  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].

  14. Wollenberg A, Oppel T. Scoring of skin lesions with the perioral dermatitis severity index (PODSI). Acta Derm Venereol. 2006;86(3):251-2. [Medline].

  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].

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  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].

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

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  29. 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].

  30. Tarm K, Creel NB, Krivda SJ, Turiansky GW. Granulomatous periorificial dermatitis. Cutis. Jun 2004;73(6):399-402. [Medline].

  31. 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 Licensing Unit for Dermatology, ENT, Ophthalmology, and Respiratory System, German Federal Institute for Drugs and Medical Devices (BfArM)
Disclosure: Almirall Hermal GmbH Grant/research funds Educational

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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