Perioral Dermatitis

Chronic inflammatory facial dermatosis

Epidemiology

  • Predominantly affects young women (20–45 years)
  • Can occur in children and men
  • Increasing incidence due to topical corticosteroid misuse
  • More common in individuals with sensitive skin or atopic background

Aetiology

  • Topical corticosteroids (most important trigger)
  • Fluorinated toothpaste
  • Heavy cosmetics, moisturizers
  • Physical sunscreens
  • Microbial factors (Demodex, fusiform bacteria – contributory, not primary)
  • Hormonal factors
  • UV exposure

Pathophysiology

  • Disruption of the epidermal barrier
  • Steroid-induced vasodilation and follicular occlusion
  • Inflammatory reaction around hair follicles
  • Rebound inflammation after steroid withdrawal

Clinical presentation

Skin Lesions

  • Multiple small erythematous papules and papulopustules
  • Occasionally vesicles
  • Characteristic sparing of the vermilion border
  • Background erythema and dryness
  • Burning or tight sensation (pruritus uncommon)
notion image

Distribution

  • Perioral region (most common)
  • Perinasal
  • Periocular (then termed periorificial dermatitis)

🧩 Classification

  • Classic perioral dermatitis
  • Periorificial dermatitis (mouth, nose, eyes)
  • Granulomatous perioral dermatitis (children; yellow-brown papules)

Investigations

  • Clinical diagnosis
  • No routine laboratory tests required
  • Skin biopsy (rare): perifollicular lymphocytic infiltrate

Management

General Measures (Cornerstone)

  • Discontinue topical corticosteroids gradually
  • Avoid cosmetics, heavy moisturizers, and irritants
  • Use gentle cleansers

Topical Treatment (First-line)

  • Clindamycin Cream 1% 1-2x/day
  • Erythromycin Cream 2-3% 1-2x/day
  • Azaleic acid Cream 20% or Gel 15% 2x/day
  • Adapalene Gel 0.1% 1x/day

Systemic Therapy

  • Oral tetracyclines (doxycycline, minocycline) for moderate–severe cases
  • Macrolides for children or pregnant patients