Clinical Derma

Perioral Dermatitis

04 Sep

INDICATION – BRIEF

Perioral dermatitis is a skin condition causing inflamed papules, primarily around the mouth, affecting mostly women aged 16-45. Clinical factors include use of potent topical steroids on the face, certain infections, and use of fluorinated toothpaste. Non-clinical factors include the use of heavy skin care products, environmental changes, hormonal shifts, and stress. The exact cause remains unknown, and while it’s not contagious, it can be chronic and recurrent. Management includes cessation of topical steroids, simplified skincare, and possibly prescribed antibiotics. It’s crucial to consult a dermatologist for proper diagnosis and treatment.

INDICATION – DEFINITION

Perioral dermatitis is a common skin condition characterized by an eruption of small, inflamed papules and pustules, primarily around the mouth (perioral area). It can also affect the areas around the nose and sometimes the eyes (periocular). Though it primarily affects women between 16-45 years of age, it can also occur in men and children.

Clinical Causal Factors:

  1. Topical Steroids: Use of potent topical corticosteroids on the face is one of the most common triggers. Steroids may initially help the condition, but when stopped, it often rebounds worse than before.
  2. Infections: Some studies suggest a role of fungal or bacterial infections, particularly from the genus Candida or Staphylococcus.
  3. Fluorinated Toothpaste: Some cases have been linked to the use of toothpaste containing fluoride.

Non-Clinical Causal Factors:

  1. Skin Care Products: Heavy skin creams and moisturizers can contribute to perioral dermatitis. Some makeup products and sunscreens may also be a factor.
  2. Environmental Factors: Changes in weather, especially cold and windy conditions, can trigger the condition. Certain environmental pollutants could also play a role.
  3. Hormonal Factors: Hormonal changes or use of oral contraceptives have been associated with the development of perioral dermatitis.
  4. Stress: Although not a direct cause, stress and anxiety can exacerbate the condition.

SYMPTOMS AND DIAGNOSIS

Symptoms: Perioral dermatitis presents as small red, inflamed bumps (papules) or pus-filled bumps (pustules) around the mouth. The skin around the nose and eyes can also be affected. Other symptoms include:

  1. Mild itching or burning sensation in the affected area
  2. Dry or flaky skin around the mouth
  3. A clear or yellowish fluid that may come from the bumps
  4. Sensitivity to sunlight

Diagnosis: The diagnosis of perioral dermatitis is primarily clinical, based on the characteristic appearance and distribution of the rash. Here’s the usual process:

  1. Medical History and Examination: The doctor will take a detailed medical history, asking about your symptoms, skincare routine, use of topical corticosteroids or cosmetics, and overall health. This is followed by a thorough examination of the skin.
  2. Dermatoscopy: In some cases, a dermatoscope might be used for a closer look at the skin.
  3. Skin culture or biopsy: These are rarely needed, but might be performed if the condition doesn’t respond to initial treatment or to rule out other conditions like rosacea, contact dermatitis, or seborrheic dermatitis.

Prognosis and Impact

Prognosis: The prognosis for perioral dermatitis is generally good, especially with timely and appropriate treatment. The condition can usually be controlled within several weeks to a few months, but it can sometimes be stubborn and take longer to resolve. Importantly, even after successful treatment, perioral dermatitis can recur, especially if the triggering factors are not adequately managed or avoided.

Impact: The primary impact of perioral dermatitis is on the patient’s quality of life, largely due to its physical appearance and potential discomfort. It can cause:

  1. Psychosocial Impact: Given its visible nature, perioral dermatitis can lead to self-consciousness or embarrassment, potentially affecting social interactions and mental well-being.
  2. Physical Discomfort: While usually not severe, the itching or burning sensation associated with perioral dermatitis can be bothersome.
  3. Skincare Routine Changes: Patients with perioral dermatitis often need to modify their skincare routines significantly, avoiding certain products that can exacerbate the condition.
  4. Medical Impact: As mentioned earlier, the condition often requires medical treatment which could be long-term in some cases.

Treatment Options

  1. Discontinuation of topical steroids: If topical steroids have been used on the face, they should be discontinued. Their withdrawal might initially worsen the condition, but improvement usually follows.
  2. Topical treatments:
    • Metronidazole cream or gel: Applied twice a day for several weeks.
    • Azelaic acid: Helps reduce inflammation and can be used for longer-term management.
    • Pimecrolimus or tacrolimus cream: These are non-steroidal anti-inflammatory creams that can help reduce inflammation.
  3. Oral antibiotics: When the condition is more severe, or if it doesn’t respond to topical treatments, oral antibiotics such as doxycycline, minocycline, or tetracycline may be prescribed for several weeks.
  4. Skincare regimen: A “zero therapy” approach is recommended, where you reduce the use of facial cosmetics, creams, and sunscreens unless specifically advised by your dermatologist.
  5. Lifestyle changes: Avoiding potential triggers such as certain cosmetic products, fluorinated toothpaste, or environmental irritants can help manage the condition.

Risks and Side Effects

  1. Discontinuation of topical steroids: Stopping topical steroids can lead to a worsening of symptoms initially, known as a “rebound” effect. This usually improves with time but may cause temporary discomfort and distress.
  2. Topical treatments:
    • Metronidazole cream or gel: Side effects can include skin irritation, dryness, redness, metallic taste, or numbness in the hands or feet.
    • Azelaic acid: Potential side effects include skin irritation, dryness, and lightening of the skin.
    • Pimecrolimus or tacrolimus cream: These can cause skin burning or stinging initially, but these side effects usually decrease with continued use.
  3. Oral antibiotics:
    • Doxycycline, minocycline, or tetracycline: These can cause side effects like stomach upset, diarrhea, skin sensitivity to sunlight, and, in women, an increased chance of vaginal yeast infections. Prolonged use of antibiotics can lead to antibiotic resistance.
  4. Skincare regimen: A “zero therapy” approach might initially exacerbate dryness and discomfort in the skin due to discontinuation of moisturizers and other products. This usually improves as the skin adapts to the new routine.
  5. Lifestyle changes: Avoiding potential triggers may not have significant risks or side effects but can be inconvenient or difficult for some people.

FAQ Section

What is perioral dermatitis?

Perioral dermatitis is a skin condition that causes small, red, inflamed bumps around the mouth. It can also affect areas around the nose and sometimes eyes. The exact cause is unknown, but it can be triggered by factors such as use of topical steroids, certain skincare products, and hormonal changes.

 

Is perioral dermatitis contagious?

No, perioral dermatitis is not contagious. You can’t catch it from or pass it to someone else.

 

How is perioral dermatitis diagnosed?

Diagnosis is primarily clinical, based on the characteristic appearance of the rash. Your dermatologist might use a dermatoscope for a closer look at your skin. Rarely, a skin culture or biopsy may be needed.

 

Can I use my usual skincare products while I have perioral dermatitis?

You may need to modify your skincare routine and avoid certain products. A minimalistic approach often called “zero therapy”, is typically recommended to help the skin recover.

 

What are the treatment options for perioral dermatitis?

Treatment options include discontinuation of topical steroids if they’ve been used, topical treatments like metronidazole cream or azelaic acid, oral antibiotics for severe cases, and lifestyle modifications to avoid potential triggers.

 

Are there any side effects to the treatment of perioral dermatitis?

Yes, some treatments can cause side effects like skin irritation, dryness, redness, stomach upset, or sensitivity to sunlight. However, not everyone experiences these, and if they do occur, they can often be managed effectively.

 

Can perioral dermatitis be cured?

Perioral dermatitis can usually be controlled with appropriate treatment. However, it can recur, especially if triggering factors are not adequately managed or avoided.

 

Does perioral dermatitis have an impact on my quality of life?

While not a severe condition, the visible nature and discomfort of perioral dermatitis can affect your social interactions, mental well-being, and daily skincare routine.

Reference

This information is in line with standard dermatology resources and references, including:

 

  1. James, William D., et al. “Andrews’ Diseases of the Skin: Clinical Dermatology.” Saunders Elsevier, 12th Edition, 2015.
  2. Bolognia, Jean L.; Schaffer, Julie V.; Cerroni, Lorenzo. “Dermatology.” Elsevier, 4th Edition, 2018.
  3. Wolff, Klaus, et al. “Fitzpatrick’s Dermatology in General Medicine.” McGraw-Hill, 8th Edition, 2012.

Additional reliable sources for this information include:

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