Who gets periorificial dermatitis?

Periorificial dermatitis and its variants mainly affect adult women aged 15 to 45 years. It is
less common in men. It may affect children of any age.

People with periorificial dermatitis are often using topical or inhaled corticosteroids.

What is the cause of periorificial or periorificial

dermatitis?
The exact cause of periorificial is not understood. Periorificial dermatitis may be related to:

Epidermal barrier dysfunction

Activation of the innate immune system
Altered cutaneous microflora
Follicular fusiform bacteria

Unlike seborrhoeic dermatitis, which can affect similar areas of the face, malassezia yeasts
are not involved in periorificial dermatitis.

Periorificial dermatitis may be induced by:

Topical steroids, whether applied deliberately to facial skin or inadvertently

Nasal steroids, steroid inhalers, and oral steroids
Cosmetic creams, make-ups and sunscreens
Fluorinated toothpaste
Neglecting to wash the face
Hormonal changes and/or oral contraceptives

What are the clinical features of periorificial dermatitis?

The characteristics of facial periorificial dermatitis are:

Unilateral or bilateral eruption on chin, upper lip and eyelids in perioral, perinasal and
periocular distribution
Sparing of the skin bordering the lips (which then appears pale), eyelids, nostrils
Clusters of 12 mm erythematous papules or papulopustules
Dry and flaky skin surface
Burning irritation

In contrast to steroid-induced rosacea, periorificial dermatitis spares the cheeks and forehead.

Genital periorificial dermatitis has a similar clinical appearance. It involves the skin on and
around labia majora (in females), scrotum (in males) and anus.

Complications of periorificial dermatitis

Granulomatous periorificial dermatitis is a variant of periorificial dermatitis that presents
with persistent yellowish papules. It occurs mainly in young children and nearly always
follows the use of a corticosteroid. There is a granulomatous perifollicular infiltrate on
histopathology.

Steroid rosacea presents with steroid-induced, large facial papules, papulopustules and
telangiectasia on the mid-face, including forehead and cheeks.

Rebound flare of severe periorificial dermatitis may occur after abrupt cessation of
application of potent topical steroid to facial skin.

How is periorificial dermatitis diagnosed?

The presentation of periorificial dermatitis is usually typical, so clinical diagnosis is usually
straightforward. There are no specific tests.

Skin biopsy shows follicular and perivascular chronic inflammation similar to rosacea.

What is the treatment for perioral dermatitis?

Periorificial dermatitis responds well to treatment, although it may take several weeks before
there is noticeable improvement.

General measures

Discontinue applying all face creams including topical steroids, cosmetics and
sunscreens (zero therapy).
Consider a slower withdrawal from topical steroid/face creams if there is a severe
flare after steroid cessation. Temporarily, replace it by a less potent or less occlusive
cream or apply it less and less frequently until it is no longer required.
Wash the face with warm water alone while the rash is present. When it has cleared
up, use a non-soap bar or liquid cleanser if you wish.
Choose a liquid or gel sunscreen.

Topical therapy

Topical therapy is used to treat mild periorificial dermatitis. Choices include:

Erythromycin
Clindamycin
Metronidazole
Pimecrolimus
Azelaic acid

Oral therapy

In more severe cases, a course of oral antibiotics may be prescribed for 612 weeks.
 Most often, a tetracycline such as doxycycline is recommended. Sub-antimicrobial
dose may be sufficient.
Oral erythromycin is used during pregnancy and in pre-pubertal children.
Oral low-dose isotretinoin may be used if antibiotics are ineffective or
contraindicated.

How can periorificial dermatitis be prevented?

Periorificial dermatitis can generally be prevented by the avoidance of topical steroids and
occlusive face creams. When topical steroids are necessary to treat an inflammatory facial
rash, they should be applied accurately to the affected area, no more than once daily in the
lowest effective potency, and discontinued as soon as the rash responds.

What is the outlook for periorificial dermatitis?

Periorificial dermatitis sometimes recurs when the antibiotics are discontinued, or at a later
date. The same treatment can be used again.