Perioral dermatitis is a common facial skin problem. Most patients with Perioral-nasal-ocular dermatitis are using multiple different types of cosmetic and medicinal creams. Most often it is red and slightly scaly or bumpy. Any itching or burning is mild. It may spread up around the nose, and occasionally the eyes while avoiding the skin adjacent to the lips. It is more rare in men and children. There may be more than one cause of perioral dermatitis. One of the most common factors is prolonged use of topical steroid creams and inhaled prescription steroid sprays used in the nose and the mouth. Overuse of heavy face creams and moisturizers are another common cause. Other causes include skin irritations, fluorinated toothpastes, and rosacea. The severity of the rash can vary from a few minor spots that are barely noticeable, to a definite and obvious unsightly lumpy rash that is around the mouth. The rash is not usually painful or itchy. Perioral dermatitis is usually characterized by an uncomfortable burning sensation around the mouth. Itching is not a common symptom. In most cases, discrete papules and vesicopustules are seen around the mouth. Rarely, a similar rash may appear around the eyes, nose, or forehead.
Perioral dermatitis may be a form of the skin disorder rosacea, adult acne or seborrheic dermatitis, involving the skin around the mouth or nose. The affected area is often worsened by sunlight and almost always by wind, heat, chlorinated pool water and even by washing with hot water. It is much harder to tell the difference between rosacea and perioral dermatitis though, because it appears the roughly the same. The only difference between the two is that rosacea causes blisters and scaly skin. If these do not appear, then it is not rosacea. Perioral dermatitis is usually just a straight forward bumpy rash. Without treatment, the condition may last months or years. Treatment can usually help. Your doctor may prescribe an antibiotic tablet in the tetracycline group. Topical antibiotics are sometimes used in milder cases. The course of treatment is usually 6-12 weeks and you may not notice any improvement for the first few weeks whilst taking treatment. However, there is an improvement in most cases within two months after starting antibiotic treatment.
Causes of Perioral dermatitis
The exact causes of Perioral dermatitis are unknown. It may appear after topical steroids are applied to the face to treat other conditions. One of the most common factors is prolonged use of topical steroid creams and inhaled prescription steroid sprays used in the nose and the mouth. Other causes include skin irritations, fluorinated toothpastes, and rosacea. The affected area is often worsened by sunlight and almost always by wind, heat, chlorinated pool water and even by washing with hot water. People may also develop dermatitis from many of the materials they touch while at work (occupational dermatitis).
Common causes and risk factors of Perioral dermatitis:
- Emotional stress.
- Toothpaste containing lauryl sulfate.
- Chlorinated pool water.
- Prolonged therapy with topical corticosteroids.
- Oral contraceptive pill.
- Yeasts and bacteria that live in hair follicles.
Signs and Symptoms of Perioral dermatitis
Perioral dermatitis is usually characterized by an uncomfortable burning sensation around the mouth. The itching is usually severe, but the rash varies from a mild, short-lived redness to severe swelling and large blisters. Most commonly, the rash contains tiny blisters. The rash develops only in areas contacted by the substance. Touching the rash or blister fluid cannot spread contact dermatitis to other people or to other parts of the body that did not make contact with the substance. People may be sensitive to many substances, and the substance they react to on a patch may not be the cause of their dermatitis.
Sign and symptoms may include the following :
- Uncomfortable burning sensation around the mouth.
- Skin lesions.
- Rarely, a similar rash may appear around the eyes, nose, or forehead.
- Fluid- or pus-filled bumps.
- Perioral dermatitis tends to be chronic.
Treatment for Perioral dermatitis
Treatment is not effective until there is no further contact with the substance causing the problem. Once the substance is removed, the redness usually disappears after a week. 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. 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.
Treatment may include:
- Topical antibacterial creams and lotions may also be used for faster relief. These can be continued for several months in order to prevent recurrences.
- Small areas of dermatitis can be soothed by applying pieces of gauze or thin cloth dipped in cool water or aluminum acetate (Burow's solution) several times a day for an hour.
- Wash the face with warm water alone while the rash is present. When it has cleared up, use a non-soap bar or liquid cleanser.
- The short term use of Protopic or Elidel can target the eczematous component of the perioral dermatitis and spare the skin further steroid use.
- In unresponsive and granulomatous forms, oral isotretinoin or isoniazid may be considered.
- In more severe cases, oral antibiotics (such as tetracycline, doxycycline, minocycline, or erythromycin) may be required.