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What is Perioral dermatitis?

Perioral dermatitis is a type of dermatitis that occurs only around the mouth, nose and eyes. It does not have to be present in all of the areas at the same time.

Some dermatologists believe that Perioral dermatitis does really exist and that patients that fit the clinical picture of Perioral dermatitis has Rosacea. Rosacea and Perioral dermatitis can sometimes be present in the same patient. Because it is always more likely that a patient has 1 condition rather than two, the finding of both Rosacea and Perioral dermatitis in the same patient support to the thesis that the 2 conditions are in fact the same. Furthermore, when looking at a sample of skin under the microscope, both Rosacea and Perioral dermatitis displays the same type of inflammation, knows as a granulomatous peri-folliculitis. The word granulomatous refers to a collection of macrophages (a type of white blood cell). Peri-folliculitis means that the “collection of macrophages” is lying in close proximity to a hair follicle.

Whether or not Rosacea and Perioral dermatitis are the same disease or two separate diseases is an academic question and not very important from a treatment perspective. The fact is that the clinical picture known as Perioral dermatitis is quite classic and most often easily recognizable and treatable.

Classically young female patients are affected. The rash consists of small red bumps (knows as papules) and occasionally small pimples (knows a pustules) occurring around the mouth, nose and eyes. Interestingly, a small margin of skin around the edge of the lips are always unaffected. As mentioned before not all 3 of these areas has to be affected at the same time.

More than 80% of patients with Perioral dermatitis have been applying corticosteroid-containing creams to the face, before the rash started to appear. In the remaining cases the cause is unclear, but the excessive use of facial products seem to be another common factor.

The treatment of this condition involves the elimination of all (if possible) facial products. If topical corticosteroid-containing creams have been used they should be tapered off slowly and not stopped suddenly, because this will lead to a flare-up of the condition.

The treatment of Perioral dermatitis involves the use of oral tetracycline antibiotics for a few months. Sometimes this is combined with antibiotic creams, but in general it is better to avoid as many creams as possible. Most often this approach results in complete clearance of the skin condition in a few weeks.

Perioral dermatitis treatment

Perioral dermatitis is sometimes also called Perioral-nasal-ocular dermatitis (PONOD) or periorificial dermatitis, because the rash can also appear around the nose and eyes.

Perioral dermatitis is associated with the use of facial products. Most patients with Perioral dermatitis are using multiple different types of facial products. The use of corticosteroid containing creams over extended periods are strongly linked to the development of Perioral dermatitis. One of the most important aspects of the treatment of Perioral dermatitis is therefore the gradual elimination of all non-essential facial products.

Depending on the severity of the Perioral dermatitis the above process is started while taking an oral Tetracycline antibiotic, like Minocycline, Doxycycline or Lymecycline. Normally this antibiotic must be continued for at least 3 months (or until the rash has disappeared) and is then tapered off over a 2 month period.

Paradoxically, the early phases of the treatment of Perioral dermatitis might involve using a mild topical corticosteroid cream on the face to calm down the active redness and inflammation. The most commonly used corticosteroid cream contains Mometasone furoate. This is initially applied daily until the redness subsides and then tapered off as soon as possible.

The tapering off process of the corticosteroid cream normally occurs over a few weeks. The average patient will use the corticosteroid cream daily for about 5 days, on alternate days for about 4 days, twice a week for about 2 weeks and after that maybe once or twice a month. There is however considerable variation.

While the corticosteroid cream is tapered off the oral antibiotic is continued until the rash has been absent for at least a month. Only then is the oral antibiotic also tapered off. It is extremely important that during this treatment period all non essential facial products (yes all!) must be gradually eliminated. If this is not entirely possible then try to eliminate as many facial products as you can. Only after all facial products have been stopped and the Perioral dermatitis has been clear for at least one month, can facial products be gradually reintroduced one by one.

Perioral dermatitis is normally quite responsive to the above treatment regime and most patients will experience a marked improvement in only a few days to weeks.