Perioral dermatitis is a relatively common facial rash with overlying features of several other disease processes. Its accurate diagnosis, while sometimes challenging, is paramount due to its unique treatment course. The presentation includes symptoms of small papules, pustules and dry, burning erythema along the perioral region, as well as along the nasolabial folds and, less commonly, lateral to the eyes. The disease presentation can resemble acne and seborrheic dermatitis, however, has a distinct presentation, typically sparing the vermillion border, cheeks, and forehead.
Perioral dermatitis is most often seen in adult women but also occurs in men and children. Its etiology is not clear, though several contributors have been identified. Children with atopic dermatitis, asthma, inhaled corticosteroid use, or application of corticosteroids on the face, have all been linked with increased risk of perioral dermatitis. In adult women, it has been hypothesized that the use of excessive moisturizers, particularly when covered with foundation, has led to increased incidence of perioral dermatitis. It is thought that the occlusive nature of this combination leads to a proliferation of skin flora. Its connection with fluorinated toothpaste is not well established in the literature.
Perioral dermatitis is most often treated orally with a tetracycline. Topical calcineurin inhibitors can be helpful as well. Many home skin care products can be irritating or perpetuating, and their discontinuation is often encouraged. Recurrence is fairly common and long-term treatment is sometimes necessary. Generally, the eruption responds well to appropriately targeted treatment over a period of several weeks.
Written by Amanda Floyd, APRN
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