Perioral Dermatitis Clinical Presentation

Updated: Jun 21, 2018
  • Author: Hans J Kammler, MD, PhD; Chief Editor: William D James, MD  more...
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Presentation

History

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

Often, long-term use of topical steroids for minor or even undiagnosed skin alterations precedes the development of perioral dermatitis.

Perioral dermatitis tends to be chronic.

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Physical Examination

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 primarily a perioral distribution. Other locations of involvement include the nasolabial fold and lateral portions of the lower eyelids. Vulvar involvement has been reported in young girls affected with perioral dermatitis.

In an extreme variant of the disease called granulomatous perioral dermatitis, granulomatous infiltrates have a yellowish aspect at diascopy. The lesions are confluent in a well-defined plaque delineated by the nasolabial folds and chin. [8]

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Complications

Although perioral dermatitis (POD) is limited to the skin and not life threatening, emotional problems may occur because of the character of the facial lesions and the possibly prolonged course of the disease.

An initial rebound effect frequently occurs during the weaning of the steroid. This phenomenon is rare when no underlying cause can be evaluated.

A chronic course is not uncommon.

The development of a lupoid dermal infiltrate is considered to be a feature of the maximal variant of the disease. The diagnosis is made on the basis of the yellowish discoloration after diascopy. This entity is called lupuslike perioral dermatitis.

Scarring may be a problem with the lupoid form of perioral dermatitis.

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