Perioral Dermatitis
Perioral dermatitis also known as periorificial dermatitis is a chronic erythematous eruption composed of small papules and papulopustules seen primarily around the mouth with a narrow zone of sparing around the vermilion border of the lip
Mostly effects caucasian women age 18-50.
Differential diagnosis
- acne vulgaris
- contact dermatitis
- rosacea
- seborrheic dermatitis
- discoid lupus
- papular sarcoid
Triggers associated with POD
- Steroid use via all routes, inhaled, nasal insufflation is the most common association. Application may be accidental (eg, nasal sprays) or intentional.
- Cosmetic use.
- Epidermal barrier dysfunction secondary to:
- Nutritional deficiencies e.g zinc or essential fatty acid deficiency
- Over use of petroleum based balms or creams such as vasoline with a heavy emollient base leads to blocked sebaceous ducts
- Sunscreen use, particularly over the counter sunscreens in children.
- Allergens/irritants eg, tooth paste and dental fillings.
- Infective organisms such as Demodex spp., Candida albicans, and fusiform bacteria have been cultured from lesions, however, their significance remains unclear.
- Hormonal changes caused by oral contraceptive use, pregnancy, and premenstrual flares have been observed.
- Atopic predisposition.
- UV light, heat, and wind seem to worsen periorificial dermatitis.
Clinical Features
- An acneiform eruption
- Clusters of skin-coloured to red papules, vesicles, and pustules
- Usually less than 2mm each; may coalesce into larger lesions
- Erythematous base with a sharp border
- Surrounding skin is often dry
- Scaly and flaky skin surface
- Burning sensation or skin tightness
- Itch
Pain is rare, although skin sensitivity is common and patients are otherwise systemically well.
Whilst usually limited to the affected orifice, more severe POD may extend to the chin, cheeks, lateral lower eyelids, upper eyelids, forehead, and glabella. The immediate peri-vermillion skin is often spared, only rarely is it affected in severe cases.
Conventional Treatment
- Treatment in
- milder cases is with a topical antibiotic e.g. - clindamycin, erythromycin or metronidazole
- severe cases - systemic antibiotics e.g. - tetracycline (oxytetracycline 500 mg BD an hour before food, lymecycline 408 mg OD an hour before food) for 4-6 weeks or erythromycin 500mg BD
NATURO TREATMENT HIGHLY EFFECTIVE see protocol
References
Primary Care Dermatology Society (PCDS) 2013. Perioral dermatitis