Perioral Dermatitis

by Kesiree Naidoo | Mar 30, 2021

If you have a rash around your mouth that is red and slightly scaly or bumpy, you may have a skin condition called perioral dermatitis.

What is perioral dermatitis?

Perioral dermatitis is a benign inflammatory condition consisting of papules, pustules and red scaly patches that occur primarily around the mouth of young, healthy people. In short, it is a scaly or red bumpy rash around the skin of the mouth.

It can also occur around the eyes and nose, and very rarely around the genitals, in which case it is referred to as periorificial dermatitis.

The main symptoms described are itching and burning.

Who gets perioral dermatitis?

Perioral dermatitis mostly affects women between the ages of 16 and 45 years old. However, it can also occur in young children, other ages and men (although less common).

What is the cause of perioral dermatitis?

The exact cause of perioral dermatitis is unknown, but there are a few theories, and, as with most conditions, there is a combination of genetic, environmental and hormonal factors.

Perioral dermatitis is thought to be due to a change in the microbial organisms that live on the skin.

Below are some factors that may trigger the condition:

  • The use of inhaled steroids or topical steroids for asthma, eczema or dermatitis.
  • A stressful lifestyle can precipitate the condition.
  • Dry skin with an impaired barrier function.
  • Using too many cosmetic products.
  • The use of heavy skin creams that contain petrolatum or a paraffin base
  • Bacterial or fungal infections
  • Fluorinated toothpaste
  • Chewing gum
  • Dental fillings
  • Candida albicans infection
  • Demodex mites

It is important to note that perioral dermatitis may still occur in the absence of any triggering factor.

What is the treatment for perioral dermatitis?

Treatment is usually a combination of a topical anti-inflammatory and a topical or oral antibiotic for six weeks; however, your doctor will determine the best treatment for you based on your condition’s severity.

Stopping the use of topical steroid creams and nasal spray will likely be recommended. Your doctor will also review the treatment of perioral dermatitis based on your initial response to the medication.

Some examples of medication that your doctor may prescribe are:

  • Topical metronidazole
  • Topical erythromycin
  • Topical clindamycin
  • Topical calcineurin inhibitors (TCI), pimecrolimus and tacrolimus
  • Topical azelaic acid
  • Oral tetracycline antibiotics, doxycycline, lymecycline
  • Oral erythromycin antibiotics
  • Oral isotretinoin

How can I prevent perioral dermatitis?

As the causes of this skin condition vary and are not yet completely understood, there, unfortunately, isn’t a foolproof way of preventing it.

However, you can follow the below guides to prevent it from getting worse and alleviate some of the symptoms:

  • Avoid using topical steroids on your face
  • Wash your face with a gentle cleanser
  • Use gentle, non-occlusive face creams to moisturise
  • Minimise the use of makeup and skincare products as much as possible

Are there any conditions related to perioral dermatitis?

Rosacea, dermatitis and perioral dermatitis are three conditions which overlap in the perioral (mouth) area. 

Steroid creams that are used for the treatment of eczema or dermatitis can precipitate perioral dermatitis. This is suspected when dermatitis does not respond to the steroid treatment. Instead, it worsens and becomes exponentially worse when the steroids are withdrawn, a sign that the dermatitis is now complicated by perioral dermatitis.

The steroid treatment of dermatitis or eczema on the face can also result in a side effect of steroid rosacea.

Other variants of perioral dermatitis are granulomatous perioral dermatitis (most commonly occurring in young males) and FIGURE (facial idiopathic granulomas with regressive evolution).

Perioral dermatitis is a challenging skin condition to treat and can reoccur in some, in which case a maintenance treatment becomes essential. If you feel that you may have perioral dermatitis, contact us today for a consultation. 

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