Periorificial Dermatitis (Perioral Dermatitis)

What is periorificial dermatitis?

Periorificial dermatitis is a facial skin condition characterized by clusters of itchy or tender red papules around facial openings like the mouth, nose, and eyes, and occasionally the genitals. It's often associated with the use of steroids (inhaled or topical), cosmetics, or moisturizers and can be mistaken for other conditions like rosacea, acne, or eczema.

What causes periorificial dermatitis?

While the exact cause of periorificial dermatitis isn't fully known, factors that may induce or exacerbate the condition include:

• Disruption of the skin barrier

• Alteration in skin microbiota

• Activation of the immune system

• Topical steroids

• Inhaled steroids, or oral steroids

• Moisturizers, cosmetics, and sunscreens

• Fluorinated toothpastes

• Hormonal fluctuations, especially those associated with pregnancy or oral contraceptives (more prevalent among women)

• Not cleansing the face of cosmetics

What are the symptoms of periorificial dermatitis?

Main features of this condition are:

• Clusters of small (1–2 mm) red papules which can sometimes be pustular

• A burning or itching sensation

• Predominant involvement of the chin, upper lip, and eyelids

Other symptoms include:

• Absence of the rash directly on the lip margins, around the eyelids, or nostrils

• Initial relief with topical steroids, followed by significant worsening upon discontinuation

• Dry or flaking skin

• Forehead usually remains unaffected

How do I treat periorificial dermatitis?

For treatment:

• Cease use of potential triggers such as facial creams, topical steroids, cosmetics, and lotion-based sunscreens

• Only rinse with warm water

Other treatments are:

• Gradual tapering of steroids if flare worsens after immediate discontinuation

• Topical antibiotics like erythromycin, clindamycin, or metronidazole

• Topical pimecrolimus

• Topical retinoids

• Topical azelaic acid

• Oral antibiotics (like doxycycline or erythromycin) for severe manifestations

• Oral isotretinoin for severe cases

How do I prevent periorificial dermatitis?

To prevent recurrence:

• Avoid topical steroids, heavy cosmetics, or occlusive facial creams

• Use topical steroids in the minimal effective dose when required

• Use liquid or gel-based sunscreens over creams or lotions

• Use non-soap cleansers

• Limit the use of skin-irritating products such as exfoliants and retinols