Perioral Dermatitis

Condition

More precisely termed periorificial dermatitis — perioral (mouth/nose), periocular/periorbital (eyes), and occasionally genital variants exist, not just the perioral form. Mainly affects women 20–50 (can occur in children/ adolescents of any age). Usually papular, sometimes pustular; may be one-sided. Unlike atopic dermatitis, typically spares a clear rim around the lips. Usually caused by topical corticosteroids (of any potency, even after months/years of prior uneventful use) — topical pimecrolimus can also cause it, though probably less often. Occlusion from cosmetics/creams is another cause; sometimes idiopathic. Patients with periorificial dermatitis commonly have coexisting rosacea, or a history of it.

Examination

Itchy or tender small red papules around the mouth (and sometimes eyes/ nose).

Management

If a cause can be identified and removed and the patient isn’t bothered by it, treatment may not be needed (“zero therapy”). If a topical corticosteroid is the cause, stop it — avoid restarting, especially for >2 weeks at a time — and warn the patient it often flares for the first couple of weeks after stopping before improving (skin is particularly sensitive during this time); a simple emollient and a cold compress (iced water) can help symptomatically.

If treatment is needed, treat as for rosacea (see Rosacea for the subtype-based approach — topical ivermectin/metronidazole/azelaic acid for papules/pustules, or oral doxycycline for more severe/refractory disease).