Perioral dermatitis, a condition related to acne vulgaris. Perioral dermatitis is a skin disorder characterized by tiny red papules (bumps) around the mouth. Perioral dermatitis (PD) affects up to 1% of the population, primarily young women ages 25-45. Children may also be affected (ages 7 months to 13 years). It is more common in developed countries. The rash looks like a cross between acne and eczema. PD does tend to affect people differently. Perioral dermatitis is usually characterized by an uncomfortable burning sensation around the mouth. Most often, patients are primarily concerned with the cosmetic appearance of skin lesions. In most cases, discrete papules (bumps) and vesicopustules (fluid- or pus-filled bumps) are seen around the mouth.
Rarely, a similar rash may appear around the eyes, nose, or forehead. Steroid creams can certainly produce, as well as aggravate this condition. Hormones may play a role. Oral contraceptives may be a factor. Gastrointestinal disturbances, such as malabsorption, have been considered as well. Cosmetic products and moisturizers in particular may worsen the rash. Face creams applied to the area bounded by the cheek folds and chin, or around the eyes in the case of periocular dermatitis. Moisturisers, cream cleansers, make-up foundation and sunscreens may all provoke perioral dermatitis. Yeasts and bacteria that live in hair follicles have been suggested as a possible trigger. The most reliably effective treatment is oral antibiotics.
Topical antibacterial creams and lotions may also be used for faster relief. These can be continued for several months in order to prevent recurrences. Tetracyclines and some other antibiotics have an action to reduce inflammation in addition to killing bacteria, and this may be why they work. Stop all face creams, lotions, cosmetics, and sunscreens being used. Wash with warm water alone until the rash improves, and then use a soap substitute to clean your face. Azelaic acid may be of benefit, and can be used during pregnancy. Avoid using any topical steroids on your face. Minimize the use of moisturizers, cosmetics should be oil-free or water based. Cover-ups can be used, but this may slow down the response of your treatment
Perioral Dermatitis Treatment and Prevention Tips
1. Stop all face creams, lotions, cosmetics, and sunscreens being used.
2. Wash the face with warm water alone while the rash is present.
3. Avoid using any topical steroids on your face.
4. Wash with warm water alone until the rash improves.
5. Minimize the use of moisturizers, cosmetics should be oil-free or water based.
6. Stop any dental products with fluoride and anti-tartar ingredients until the rash has resolved.
Perioral dermatitis is a common facial skin problem in adult women. It rarely occurs in men. It may occasionally affect children. Groups of itchy or tender small red papules (bumps) appear most often around the mouth. They spare the skin bordering the lips (which then appears pale) but develop on the sides of the chin, then spreading to include upper lip and cheeks. The rash looks like a cross between acne and eczema. PD does tend to affect people differently. Perioral dermatitis is usually characterized by an uncomfortable burning sensation around the mouth. Most often, patients are primarily concerned with the cosmetic appearance of skin lesions. In most cases, discrete papules (bumps) and vesicopustules (fluid- or pus-filled bumps) are seen around the mouth.
Causes
Perioral dermatitis most commonly affects young women. However, it may sporadically affect men. While its exact cause is unknown, it may appear after topical steroids are applied to the face to treat other conditions.
Symptoms
Perioral dermatitis is usually characterized by an uncomfortable burning sensation around the mouth. Itching is not a common symptom.
Dermatitis may be a brief reaction to a substance. In such cases it may produce symptoms, such as itching and redness, for just a few hours or for only a day or two. Chronic dermatitis persists over a period of time. The hands and feet are particularly vulnerable to chronic dermatitis, because the hands are in frequent contact with many foreign substances and the feet are in the warm, moist conditions created by socks and shoes that favor fungal growth.
Perioral Dermatitis Treatment
Anti-inflammatory systemic and/or topical therapy is required. Recently, photodynamic therapy (PDT) has been reported to be helpful,2 although large studies have not yet been performed.
Treatment should be adapted to the severity and extension of the disease.
A mild soap or soap substitute, such as Dove or Cetaphil should be used for washing. Scrubbing should be avoided. Try stopping fluorinated toothpaste for stubborn cases. Non-fluorinated toothpaste is available at a health food store. The most reliably effective treatment is oral antibiotics. These are taken in decreasing doses for three to twelve weeks. Topical antibacterial creams and lotions may also be used for faster relief. These can be continued for several months in order to prevent recurrences.
Oral therapy (pills and capsules):
If you get adequate treatment, your chances of having it recur are low. Most perioral dermatitis sufferers will see improvement after 4-6 weeks, but some need to take it for longer periods. Oral therapy includes oral antibiotics such as:
* Minocycline 50-100 mg twice a day until clear, which is usually 1-2 months, though some will continue at a lower dose for an additional month
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