Perioral dermatitis (also related – periocular dermatitis and periorifacial dermatitis)

Latest update 02/12/2010

This chapter is set out as follows:

• Introduction
• Aetiology
• Key diagnostic features
• Management

Introduction

• Perioral dermatitis is an erythematous eruption of small papules and papulopustules with a distribution primarily around the mouth
• It is a poorly named condition as it is not a dermatitis

Aetiology

• Although the exact cause of perioral dermatitis is not understood, the use of topical steroid therapy either directly or indirectly (e.g. the area has been touched by fingers that are treating another part of the body with steroid creams) is for many an important aetiological factor
• The rash may also be induced by cosmetics, moisturisers and sunscreens

Key diagnostic features

• Sex – the condition predominates in younger women
• Symptoms -  can be itchy or sore
• Distribution
  • Nasolabial areas – this can be the first sign
  • Perioral skin (with sparing of the lip margins)
  • Periocular skin involvement is less common – if this is the main site then the condition is best referred to as periocular dermatitis or periorifacial dermatitis
• Morphology
  • Monomorphic small papules and pustules
  • Erythema
  • Occasional scaling
  • Unlike rosacea, facial flushing and telangiectasia are not features of perioral dermatitis

Management

• Discontinue topical steroids or any other facial creams that may be causing the symptoms. Wash with plain water
• Warn patients that after withdrawal of the steroid cream the symptoms are likely to get worse for a few days before starting to improve
• Take care if using topical steroids at a site distant to the face e.g. if being used to treat eczema – make sure hands are washed after application so that the steroid is not transferred onto the face
• Patients may require treatment with:
  • Milder cases - a topical antibiotic e.g. clindamycin, erythromycin or metronidazole
  • A systemic antibiotic for 4-6 weeks e.g. a tetracycline (oxytetracycline 500 mg BD an hour before food, lymecycline 408mg OD an hour before food) or erythromycin 500 mg BD
• Recurrent symptoms can be managed in the same way

	Figure 1 - Erythema of the nasolabial area can be the first sign in peri-oral dermatitis At this stage the differential diagnosis includes seborrhoeic dermatitis
	Figure 2 - Erythema, papules and some pustules Note the sparing of the lip margins
	Figure 3 - Erythema with monomorphic papules
	Figure 4 - Peri-oral dermatitis induced by topical steroids This patient had been using eumovate cream to treat her angular cheilits