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Perioral dermatitis
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Perioral dermatitis
Perioral dermatitis, also known as periorificial dermatitis, is a common type of inflammatory skin rash. Symptoms include multiple small (1–2 mm) bumps and blisters sometimes with background redness and scale, localized to the skin around the mouth and nostrils. Less commonly, the eyes and genitalia may be involved. It can be persistent or recurring, and resembles particularly rosacea and to some extent acne and allergic dermatitis. The term "dermatitis" is a misnomer because this is not an eczematous process.
The cause is unclear. Topical steroids are associated with the condition and moisturizers and cosmetics may contribute. The underlying mechanism may involve blockage of the skin surface followed by subsequent excessive growth of skin flora. Fluoridated toothpaste and some micro-organisms, including Candida may also worsen the condition, but their roles in this condition are unclear. It is considered a disease of the hair follicle with biopsy samples showing microscopic changes around the hair follicle. Diagnosis is based on symptoms.
Treatment is typically by stopping topical steroids, changing cosmetics, and in more severe cases, taking tetracyclines by mouth. Stopping steroids may initially worsen the rash. The condition is estimated to affect 0.5-1% of people each year in the developed world. Up to 90% of those affected are women between the ages of 16 and 45 years, though it also affects children and the elderly, and has an increasing incidence in men.
The disorder appears to have made a sudden appearance with a case of 'light sensitive seborrhoeid' in 1957, which is said to be the first nearest description of the condition. By 1964, the condition in adults became popularly known as perioral dermatitis, but without clear clinical criteria. In 1970, the condition was recognized in children. Whether all rashes around the mouth are perioral dermatitis has been frequently debated. That this condition should be renamed periorificial dermatitis has been proposed. Darrell Wilkinson was a British dermatologist who gave one of the earliest 'definitive' descriptions of 'perioral dermatitis' and noted that the condition was not always associated with the use of fluoridated steroid creams.
A stinging and burning sensation with rash is often felt and noticed, but itching is less common. Often, the rash is steroid responsive, initially improving with application of topical steroid. The redness caused by perioral dermatitis has been associated with variable levels of depression and anxiety.
Initially, there may be small pinpoint papules on either side of the nostrils. Multiple small (1-2mm) papules and pustules then occur around the mouth, nose and sometimes cheeks. The area of skin directly adjacent to the lips, also called the vermillion border, is spared and looks normal. There may be some mild background redness and occasional scale. These areas of skin are felt to be drier and therefore there is a tendency to moisturize them more frequently. Hence, they do not tolerate drying agents well, and they often worsen the rash.
Perioral dermatitis is also known by other names, including rosacea-like dermatoses, periorofacial dermatitis and periorificial dermatitis. Unlike rosacea, which involves mainly the nose and cheeks, there is no telangiectasia in perioral dermatitis. Rosacea also has a tendency to be present in older people. Acne can be distinguished by the presence of comedones and by its wider distribution on the face and chest. There are no comedones in perioral dermatitis.
A variant of perioral dermatitis called granulomatous perioral dermatitis (GPD) is often seen in prepubertal children or in darker skin phenotypes. GPD lesions may appear yellow on a diascopy. Patients report irritation but are usually asymptomatic. For children with GPD, a skin biopsy showing granulomatous infiltrate is needed to confirm diagnosis in an atypical patient. If the GPD is mild, treatment is not mandatory.
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Perioral dermatitis
Perioral dermatitis, also known as periorificial dermatitis, is a common type of inflammatory skin rash. Symptoms include multiple small (1–2 mm) bumps and blisters sometimes with background redness and scale, localized to the skin around the mouth and nostrils. Less commonly, the eyes and genitalia may be involved. It can be persistent or recurring, and resembles particularly rosacea and to some extent acne and allergic dermatitis. The term "dermatitis" is a misnomer because this is not an eczematous process.
The cause is unclear. Topical steroids are associated with the condition and moisturizers and cosmetics may contribute. The underlying mechanism may involve blockage of the skin surface followed by subsequent excessive growth of skin flora. Fluoridated toothpaste and some micro-organisms, including Candida may also worsen the condition, but their roles in this condition are unclear. It is considered a disease of the hair follicle with biopsy samples showing microscopic changes around the hair follicle. Diagnosis is based on symptoms.
Treatment is typically by stopping topical steroids, changing cosmetics, and in more severe cases, taking tetracyclines by mouth. Stopping steroids may initially worsen the rash. The condition is estimated to affect 0.5-1% of people each year in the developed world. Up to 90% of those affected are women between the ages of 16 and 45 years, though it also affects children and the elderly, and has an increasing incidence in men.
The disorder appears to have made a sudden appearance with a case of 'light sensitive seborrhoeid' in 1957, which is said to be the first nearest description of the condition. By 1964, the condition in adults became popularly known as perioral dermatitis, but without clear clinical criteria. In 1970, the condition was recognized in children. Whether all rashes around the mouth are perioral dermatitis has been frequently debated. That this condition should be renamed periorificial dermatitis has been proposed. Darrell Wilkinson was a British dermatologist who gave one of the earliest 'definitive' descriptions of 'perioral dermatitis' and noted that the condition was not always associated with the use of fluoridated steroid creams.
A stinging and burning sensation with rash is often felt and noticed, but itching is less common. Often, the rash is steroid responsive, initially improving with application of topical steroid. The redness caused by perioral dermatitis has been associated with variable levels of depression and anxiety.
Initially, there may be small pinpoint papules on either side of the nostrils. Multiple small (1-2mm) papules and pustules then occur around the mouth, nose and sometimes cheeks. The area of skin directly adjacent to the lips, also called the vermillion border, is spared and looks normal. There may be some mild background redness and occasional scale. These areas of skin are felt to be drier and therefore there is a tendency to moisturize them more frequently. Hence, they do not tolerate drying agents well, and they often worsen the rash.
Perioral dermatitis is also known by other names, including rosacea-like dermatoses, periorofacial dermatitis and periorificial dermatitis. Unlike rosacea, which involves mainly the nose and cheeks, there is no telangiectasia in perioral dermatitis. Rosacea also has a tendency to be present in older people. Acne can be distinguished by the presence of comedones and by its wider distribution on the face and chest. There are no comedones in perioral dermatitis.
A variant of perioral dermatitis called granulomatous perioral dermatitis (GPD) is often seen in prepubertal children or in darker skin phenotypes. GPD lesions may appear yellow on a diascopy. Patients report irritation but are usually asymptomatic. For children with GPD, a skin biopsy showing granulomatous infiltrate is needed to confirm diagnosis in an atypical patient. If the GPD is mild, treatment is not mandatory.
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