Perioral Dermatitis

• Definition
 Perioral dermatitis is characterized by small, discrete papules and
pustules in a periorificial distribution, pre-dominantly around the mouth.

• Epidemiology
 Age of onset 16–45 years; can occur in children and the old
 Females predominantly

• Etiology
 Unknown but may be markedly aggravated by potent topical (fluorinated)
glucocorticoids.
• Clinical Manifestation
 Duration of lesions are weeks to months
 itching or burning, feeling of tightness.
 Lesions discrete erythematous micropapules and microvesicle on an
erythematous background irregularly grouped, symmetric. Lesions increase in
number with central confluence and satellites; confluent plaques may appear
eczematous with tiny scales.
 There are no comedones
 Initially perioral. Rim of sparing around the vermilion border of lips nasiolabial; at
times, in the periorbital area. Uncommonly, only periorbital.
• Diagnosis
 Culture: Rule out S. aureus infection.

• Differential Diagnosis
 Allergic contact dermatitis
 atopic dermatitis
 seborrheic dermatitis
 rosacea
 acne vulgaris
 steroid acne.
• Differential Diagnosis
• Management
Topical
 Avoid topical glucocorticoids
 metronidazole, 0.75% gel two times daily or 1% once daily;
erythromycin 2% gel applied twice daily.
Systemic
 Minocycline or doxycycline 100 mg daily until clear, then 50
mg daily for another 2 months (caution, doxycycline is a
photosensitizing drug) or
 Tetracycline, 500 mg twice daily until clear, then 500 mg
daily for 1 month, then 250 mg daily for an additional month.