Perioral Dermatitis – Causes, Symptoms and Treatment

Perioral dermatitis is a skin disorder characterized by small red bumps that are seen predominantly around the mouth. Perioral dermatitis is commonly seen in young females and accounts for almost 80-90% of the total adult cases. The granulomatous form of perioral dermatitis has been reported commonly in children of prepubertal age. Perioral dermatitis is often chronic and disfiguring which affects patient’s lifestyle and self-esteem. This condition is very common and it tends to come and go in many people over time

Perioral Dermatitis Causes

The exact cause of perioral dermatitis is unclear. POD is thought to be a multifactorial disease caused by several factors that are listed below:

• Topical steroid preparations
• Nasal steroids and steroid inhalers.
• Fluoride containing toothpaste
• Skin care products containing paraffin and petrolatum as base.
• Regular use of foundation makeup
• physical sunscreens
• UV light, heat, and wind
• Candidial and fungal or bacterial infection
• Hormonal changes
• Oral contraceptives
• Malabsorption

Perioral Dermatitis Symptoms

Perioral dermatitis is commonly associated with burning sensation around the mouth. The red tiny bumps may be filled with fluid or pus. These bumps rarely itch. Such rash may also be seen on periorbital area and forehead and may be mistaken for acne. These lesions are usually symmetrically distributed but may also be unilateral. The granulomatous variant of perioral dermatitis manifests as tiny, red, yellow-brown or flesh-colored bumps. These lesions may also appear on scalp, ears, scalp, trunk, extremities and labia majora.

Perioral Dermatitis Pictures

Perioral Dermatitis

perioral dermatitis

How is Perioral Dermatitis Diagnosed?

Perioral dermatitis can be diagnosed just by direct examination by a dermatologist. Your dermatologist may also perform some tests if he suspects the causative agents to be fungal or bacterial origin.

Other conditions that may resemble perioral dermatitis

• Allergic contact dermatitis
• Irritant contact dermatitis
• Acne
• Rosacea
• Lupus miliaris disseminates faciei
• Seborrheic dermatitis
• Lip-licking cheilitis
• Gram-negative folliculitis

Perioral Dermatitis Treatment

Perioral dermatitis is often very difficult to treat successfully. It usually requires several months of treatment. Recurrence of bumps is common, especially if you unknowingly apply skin creams containing steroids on your face or use any other products that are known to be aggravating factors.

Treatment options are targeted towards the underlying cause of the perioral dermatitis. If topical corticosteroids are being used, they should be stopped immediately. It is wise to stop using all cosmetics, makeups and skin care products for some time. Avoid using foundations with moisturizers as it can aggravate the condition. One study showed that applying foundation in addition to moisturizer and night cream resulted in a 13-fold increased risk for perioral dermatitis, so avoid using it. However, moisturizer alone has no increase risk for POD. Always use mild soap-free cleansers and wash your face twice daily. Avoid using toothpaste containing fluoride or other products that contain chloride. For mild cases of perioral dermatitis topical antibiotics like metronidazole may be given. Other topical medications include clindamycin, erythromycin, azelaic acid, Benzoyl peroxide, Tacrolimus, Pimecrolimus, etc.

In case of moderate to severe disease, your doctor may prescribe combination therapy of topical medication with oral medications like oral doxycycline, tetracycline or minocycline for a course of 8-10 weeks. Patients with tetracycline allergy or children below 8 years and nursing mothers may be given oral erythromycin. Photodynamic therapy with topical 5-aminolevulinic acid has also shown some promising results in treating perioral dermatitis.