What is Perioral Dermatitis?
Perioral dermatitis is a harmless skin condition that usually happens in young adult women. It causes tiny inflamed bumps (papules), pus-filled bumps (pustules), or red, scaly patches around the mouth. Sometimes, instead of, or in addition to the mouth area, it can also appear around your eyes and nose. That’s why it is sometimes called periorificial dermatitis: ‘Peri-‘ meaning around, ‘orificial’ relating to an opening on the body. One of the main causes of this disease is the use of topical steroids (creams or ointments applied to the skin). As such, one of the first things you can do if you have this condition is to stop using those treatments. Other treatment options include different creams and lotions, specifically metronidazole and calcineurin inhibitors, or tetracycline antibiotics that you take by mouth. Perioral dermatitis often improves quickly with treatment, but it can also be a long-term condition that comes back repeatedly.
What Causes Perioral Dermatitis?
The exact cause of perioral dermatitis, a skin condition that causes a rash around the mouth, is not known for certain yet. It can be linked to a variety of environmental factors. Some people may develop this condition after using a topical corticosteroid, a type of cream or ointment that contains steroids, frequently and for a long period of time. Initially, the rash may improve when using the steroid cream, but gets worse once the cream is stopped. This can lead to a long-term reliance on the steroid cream.
Over time perioral dermatitis can worsen and can turn into another type of disease if the steroid cream is used for a long time. Perioral dermatitis can also occur with the use of nasal and inhaled steroids, not just topical ones.
Scientists are not exactly sure yet why people who use topical steroids may get perioral dermatitis, but some think it could be because steroids change the tiny organisms living on our skin and in our hair follicles, leading to the conditions that cause the rash.
Some researchers think that infections might also cause perioral dermatitis. Certain organisms like Candida albicans (a type of fungus), fusiform bacteria (a type of bacteria), and Demodex mites (small creatures that live on our skin) have been suggested as potential causes.
Using toothpaste that contains fluoride, chewing gum, and having dental fillings have also been linked to perioral dermatitis. Certain cosmetics, such as using moisturizers and foundations together, or using physical sunscreens, have also been known to lead to this condition in some cases.
Considering that perioral dermatitis is more common in women, hormones might play a role as well. Interestingly, birth control pills have been seen to improve this condition.
Risk Factors and Frequency for Perioral Dermatitis
Perioral dermatitis, a skin condition, often affects young adult women between 20 and 45 years old. However, it can also occur in children. When it comes to kids, the condition doesn’t single out any specific gender or race – it affects them all equally.
Signs and Symptoms of Perioral Dermatitis
Perioral dermatitis is a skin condition that usually shows up as red spots, which are often grouped together, typically around the mouth, eyes, and nose. This can be on both sides of the face or just one. Because it often appears around the facial openings, it’s sometimes called periorificial dermatitis. Some people may also have additional signs like skin peeling, blister-like spots, or pus-filled bumps.
The condition usually doesn’t affect the edges of the lips. In a different form known as granulomatous variant, people may present with flesh-colored, red, or yellow-brown spots in the same places, but there might also be rare involvement of the ears, neck, scalp, body, and intimate areas (such as vulva and extremities).
- Red spots, often grouped together, around the mouth, eyes, and nose
- Potential for skin peeling, blister-like spots, or pus-filled bumps
- Doesn’t affect the edges of the lips
- In granulomatous variant, flesh-colored, red, or yellow-brown spots may also occur on the ears, neck, scalp, body, and intimate areas (rare)
People with this condition often say the affected areas feel like they’re burning or sensitive, and sometimes they might feel itchy. They may also report that certain skincare products seem to make the rash worse. In rare cases, granulomatous periorificial dermatitis might also be accompanied by eye problems like blepharitis (inflammation of the eyelid) or conjunctivitis (also known as pink eye), so it can be a good idea to get an eye exam. However, perioral dermatitis doesn’t typically come with other body-wide symptoms.
A more severe form of perioral dermatitis is Lupoid perioral dermatitis. People with this condition show dense clusters of red-brown spots with lupoid infiltrate on diascopy, a type of skin test.
Testing for Perioral Dermatitis
If your doctor suspects you have perioral dermatitis, they can usually diagnose it based on your symptoms and a visual exam of your skin. However, in some cases where the symptoms aren’t typical or treatment isn’t working, a skin biopsy might be needed. A biopsy involves taking a small sample of skin to look at under a microscope.
Your doctor may also decide to test for bacteria if it’s thought that this might be contributing to your skin issues. This test, known as a culture, involves taking a small sample and allowing the bacteria to grow in a lab so it can be studied.
If your doctor suspects that a type of yeast called Candida could be involved, they might take a scraping of your skin and treat it with a chemical called potassium hydroxide. This test can help identify whether Candida is present.
Lastly, if your case of perioral dermatitis is more severe, an experienced clinician could perform a test called diascopy. Diascopy involves pressing a clear piece of glass against the skin to see how the color of the skin lesions changes. This can help your clinician understand what’s causing the condition and how to treat it.
Treatment Options for Perioral Dermatitis
Perioral dermatitis, a skin condition that affects the area around the mouth, can be managed by various treatment methods. Preferred initial treatment options include creams or gels that contain metronidazole, clindamycin, erythromycin, sulfur preparations, or azelaic acid. In treating perioral dermatitis, antibiotics are often beneficial due to their anti-inflammatory properties.
There are also different topical products such as tacrolimus ointment or pimecrolimus cream that can be effective. Even topical sulfur or sulfacetamide preparations, and topical adapalene, have shown improvement in treating this skin condition. Some individuals have reported benefits from using photodynamic therapy, a method that uses a photosensitive drug to damage certain skin cells.
However, if the dermatitis is widespread or doesn’t respond to topical therapies, oral antibiotics are commonly useful. These could be tetracycline, doxycycline, or minocycline, usually taken for eight to twelve weeks. If these antibiotics are to be avoided due to certain reasons like for children under age 8, nursing mothers, pregnant women, then erythromycin can be utilized as a substitute.
The advantage of oral antibiotics is they can provide rapid improvement. However, topical therapies need to be used at the same time. Topical treatments may not reach their full effectiveness until after three months of daily application. Therefore, the goal is to stop oral antibiotics after three months, if possible. But some patients may need to continue on oral antibiotics if they can’t manage their condition with daily topical therapies alone. For particularly stubborn and severe cases, a low-dose of oral isotretinoin, a form of vitamin A, can be used.
Keep in mind that applying topical corticosteroids is not a recommended treatment for perioral dermatitis. While they may temporarily help, discontinuing their use can often result in the rash getting worse. Patients who have been using these types of steroid creams should expect that the skin condition will likely get worse before it starts to improve with the right treatment for perioral dermatitis. If patients have been using a medium to high potency steroid, it may need to be gradually decreased using a low potency steroid like hydrocortisone cream.
What else can Perioral Dermatitis be?
Rosacea usually shows up as red, inflamed bumps and pus-filled spots, mainly on the center of the face, including the nose. This can often be accompanied by redness and flushing of the face. Many experts believe that a condition known as perioral dermatitis could be a form of rosacea, as they both typically respond well to the same treatments. One way to tell rosacea apart from acne vulgaris is the lack of blackheads or whiteheads, which are common in acne.
Acne vulgaris also presents with red, inflamed bumps, pus-filled spots, cysts, and blackheads or whiteheads, but these primarily appear on the face, chest, and back. Some people might experience acne breakouts due to mechanical causes, like wearing a helmet chin strap, which can mimic perioral dermatitis. A subtype of acne called adult female acne, characterized by inflamed bumps on the chin and jawline, can also look similar to perioral dermatitis.
Sarcoidosis may also show signs that resemble rosacea and perioral dermatitis with reddish-brown bumps around the facial openings. Usually, these sarcoidosis symptoms are more widespread and can show up in other areas of the skin. People with sarcoidosis often have other symptoms unrelated to the skin. A skin biopsy can help confirm if it is sarcoidosis. Seborrheic dermatitis presents as red patches with a greasy scale distribution in areas like the eyebrows, forehead, around the nostrils, nasolabial folds, beard, scalp, and chest.
It’s also important to consider allergic contact dermatitis, which can present as red, scaly, and thickened patches of skin. If there’s no improvement for perioral dermatitis with conventional treatments, patch testing could be useful to rule out allergic contact dermatitis from skincare or oral care products.
Irritant cheilitis, often as a result of lip licking, results in redness and scaly skin on the lips. Unlike perioral dermatitis, it also affects the red part of the lip and isn’t limited to the skin around the lips.
Demodex folliculitis is a condition characterized by scattered red spots and pus-filled spots on the face. They are caused by demodex mites, which have also been thought to play a role in rosacea. To diagnose this condition, the pus-filled spots are opened and checked under a microscope for the presence of these mites.
Tinea faciei presents with red, scaly spots and ring-like plaques and can be ruled out by taking a sample with potassium hydroxide (KOH) preparation and looking at the scaly tissue under a microscope.
Lastly, conditions like syringomas and other skin conditions that affect the skin’s accessory structures can also look like perioral dermatitis. These tend to be normal-flesh-colored to red spots on the face. A skin biopsy can help diagnose these conditions.
What to expect with Perioral Dermatitis
In some cases, if a person stops using certain products like topical steroids and skincare items, their skin rash may completely disappear. However, a skin condition called perioral dermatitis, which commonly affects the area around the mouth, often comes back again and again. Because of this, it typically requires long-term treatment.
Possible Complications When Diagnosed with Perioral Dermatitis
Lupus, a long-term disease, can cause emotional distress. Another challenging aspect is the potentially disfiguring skin lesions, particularly on the face, which can significantly decrease the quality of life. Certain types of lupus, like the lupoid variant, might also lead to scarring.
Potential Impacts:
- Emotional distress due to long-term disease
- Decreased quality of life due to disfiguring facial lesions
- Possibility of scarring with the lupoid variant of lupus
Preventing Perioral Dermatitis
As mentioned before, if you have perioral dermatitis—a type of skin condition—it’s important to understand the contribution that topical steroids (skin creams or ointments containing steroids) make to your condition. Along with stopping the use of these steroids or any other substances that can trigger symptoms, you should also cease using all other skin products, except for those medications specifically prescribed by your healthcare provider.
It’s crucial for you to understand that the treatment needed to get your condition under control might take weeks or even months. The possibility of symptoms persisting over a long period should also be openly discussed. This means that your condition can become chronic, lasting a long time or recurring often. Your doctor will explain this in further detail, helping you to understand what you can expect moving forward.
