eMedicine Specialties > Dermatology > Diseases of the Adnexa

Perioral Dermatitis

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

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.

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].

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

  14. Oppel T, Pavicic T, Kamann S, Bräutigam 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].

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

  16. 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].

  17. 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].

  18. 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].

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  21. 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].

  22. Knautz MA, Lesher JL Jr. Childhood granulomatous periorificial dermatitis. Pediatr Dermatol. Mar-Apr 1996;13(2):131-4. [Medline].

  23. Kuflik JH, Janniger CK, Piela Z. Perioral dermatitis: an acneiform eruption. Cutis. Jan 2001;67(1):21-2. [Medline].

  24. Landow K. Relief from perioral dermatitis. Postgrad Med. Sep 1998;104(3):34-5. [Medline].

  25. Laude TA, Salvemini JN. Perioral dermatitis in children. Semin Cutan Med Surg. Sep 1999;18(3):206-9. [Medline].

  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].

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

  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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