Perioral Dermatitis Clinical Presentation

Updated: Apr 27, 2017
  • 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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Causes

An underlying cause of the perioral dermatitis (POD) cannot be detected in all patients. The etiology of perioral dermatitis is unknown; however, long-term use of topical steroids for minor skin alterations of the face often precedes the manifestation of the disease. Note the following:

  • 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. Perioral dermatitis has also been reported after the use of nasal steroids [3] and steroid inhalers.

  • Cosmetics: Fluorinated toothpaste [4, 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. 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. Research from 2015 suggests to differentiate perioral dermatitis caused by rod-shaped bacteria (possible fusobacteria) and corticosteroid-induced rosacea. [7]

  • Miscellaneous factors: Hormonal factors are suspected because of an observed premenstrual deterioration. Oral contraceptives may be a factor.

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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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