Facial Rash? Perioral Dermatitis: Making The Diagnosis – OnlineDermClinic

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In this tutorial, Chris Schach M.D. discusses the characteristics this common acneiform eruption commonly seen in women and children. Learn about other dermatological conditions by visting our website.

Key Points
*Common skin condition typically affecting the skin surrounding the mouth and nose
*Exact cause is unknown, may be related to microorganisms in follicles, irritants, or use of certain topical medications
*Majority of affected persons are women and children
*Consists of groupings of small red bumps which may be accompanied by itching or sensitivity with a scaly red rash

Perioral dermatitis is a common skin condition which typically affects the skin surrounding the mouth (perioral) and the nose (perinasal). Occasionally, the rash will surround the eyes (periocular) The condition consists of groupings of small, red bumps which may be accompanied by itching or tenderness. Skin in the affected area may be flaky, dry and pink in color. The area tends to be sensitive and may sting or burn with minimal irritation. Lesions usually occur around the mouth, and often involve the skin around the nose as well. Lesions may also spread to the skin of the chin, cheeks and eyes.

The exact cause of perioral dermatitis is unknown. There are several factors which may be related to its development, most likely a hormonal change leading to a regional overgrowth of the skin’s colonizing microorganisms. This condition is similar to acne in that it seems to be triggered by hormones and possibly the acne bacteria known as P. Acnes. It also has small papules(bumps) and pustules(pimples) but is on a background of red flaky skin. Other contributing factors may include use of certain irritants (like exfoliating lotions or scrubs), some cosmetics (often anti-aging creams), or topical corticosteroids (including nasal spray steroids). The condition very rarely affects men, but it often develops in prepubertal boys and girls.

Differential Diagnosis (Other conditions with similar appearance)
Acne Vulgaris
Contact Dermatitis, Allergic
Contact Dermatitis, Irritant
Seborrheic dermatitis

Key Points
*Diagnosis based on appearance of the affected area
*Other testing is not typically required

Perioral dermatitis is diagnosed based on the characteristic appearance of the affected area. Other testing is not typically required.

*Condition is very responsive to therapy
*Ceasing use of irritants and proper facial care is recommended. Stop topical steroids
*Antibiotics may be prescribed to treat the condition

Perioral dermatitis is responsive to therapy. Foremost, ceasing use of irritants (cosmetics, moisturizers, topical steroids, etc), and washing the face with warm water and a soap substitiute is recommended. Health care professionals may prescribe a course of antibiotics (usually of the tetracycline class). In pregnant women, azaleic acid or topical clindamycin may be prescribed. In some cases, the condition may recur, but will still respond to therapy.

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