Perioral dermatitis
Also called periorificial dermatitis
Clusters of small red papules and pustules on scaly skin around the mouth, sparing a clear rim beside the vermilion border, mostly in young women, and very often fed by the topical steroid being used to treat it.
How it looks
Grouped monomorphic erythematous micropapules and pustules with fine scale around the mouth, sparing the immediate vermilion border.
Rose is the lesion, grey the pattern the lesions make, green where on the body it lives.
Across skin tones
In deeply pigmented skin the papules read flesh-toned or hyperpigmented rather than red, and the condition resolves with pigment change; the granulomatous periorificial variant is particularly seen in children with darker skin.
Don't miss
It flares when the steroid stops, which convinces everyone the steroid was working; escalating potency perpetuates the disease indefinitely.
Symptoms & course
- Burning or tightness more than itch
- Flares whenever topical steroids are stopped, which invites more steroid
Diagnostic approach
- Clinical diagnosis
- The drug history IS the investigation: topical, inhaled, and even nasal corticosteroids
Differential, and how to separate them
- Rosacea
Favours it: Central facial papulopustules in the same demographic
Against it: Rosacea centres on cheeks and nose with flushing; perioral dermatitis rings the mouth and spares the lip margin
- Acne vulgaris
Favours it: Facial papules and pustules
Against it: No comedones, and the sharply perioral clustering is not acneiform
- Seborrheic dermatitis
Favours it: Scaly erythema of the nasolabial region
Against it: Seborrheic dermatitis is patches and greasy scale without the monomorphic papules
Management principles
- Stop topical steroids, warning that a withdrawal flare precedes the cure
- Zero therapy or gentle skin care alone for mild disease
- Topical metronidazole or oral tetracyclines for the rest
Clinical pearl: The spared pale rim immediately around the lips is the single most useful sign; acne and eczema do not draw that line.
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