What is perioral dermatitis?
Perioral dermatitis, also known as periorificial dermatitis, is a chronic skin condition that involves skin around the mouth. The inflammatory rash may also affect the nose as well as the eyes.
This facial dermatitis is mostly diagnosed in the children and women aged between 16 and 45 years but can affect all ages, races and gender. Approximately 0.5-1% of people are affected by this condition each year in developed countries like the USA.
The clinical symptoms of perioral dermatitis includes red and scaly bumpy rash around the mouth that causes itching and burning sensation or in few cases, a clear fluid discharge.
The symptoms are not life-threatening but it may last for few weeks and in severe cases, it may take months to treat the condition.
What causes perioral dermatitis?
The exact cause for the occurrence of perioral dermatitis is not known. However, research suggests that the manifestation of the condition may result from the prolonged use of strong topical steroids on skin to treat some other condition. Corticosteroids containing nasal sprays or creams may cause perioral dermatitis in a few people.
Certain ingredients in the cosmetic products are also likely to favor the development of this skin condition. Hence, during the course of treatment, the doctor may strongly restrict you from using any topical preparations such as cosmetics. Skin creams formulated with petrolatum or a paraffin base may alleviate the symptoms of this condition.
Other factors that are likely to be causes of perioral dermatitis include:
- bacterial or fungal infections
- constant drooling
- oral contraceptives
- fluoridated toothpaste
- sunscreen lotion/creams and other heavy cosmetic products
What are the symptoms of perioral dermatitis?
The following symptoms may mark the onset of perioral dermatitis in most affected cases:
- This type of dermatitis usually appears as a papular rash or pus-filled bumps (pustules) around the mouth and in the areas around the nose.
- These bumps can also look scaly.
- The dermatitis may also affect the area under the eyes, on the forehead, and on the chin.
- In a few cases, these bumps may resemble acne due to similar small size and containing pus or clear fluid.
- If the symptoms aggravate, they can cause burning or itching in the affected areas.
How is perioral dermatitis diagnosed?
The appearance of your skin can help the doctor or dermatologist diagnose perioral dermatitis. The doctor may visually examine the affected skin and inquire about your medical history to provide a better medical intervention.
Although, no tests are carried out to detect the signs of the dermatitis, skin culture test may be recommended to eliminate the possibility of bacterial or fungal infection.
This quick and simple test involves taking a sample from the affected area of the skin. The sample is then tested in the laboratory for the presence of bacterial or fungal cells. Skin biopsy may be performed depending upon the severity of the condition and negative response to standard treatments.
What is the treatment for perioral dermatitis?
It is necessary to seek medical care to help treat your condition. Your doctor may ask to restrict the usage of any strong topical steroid creams or nasal sprays formulated with steroids during the initial phase of the treatment for perioral dermatitis.
The application of such creams or lotions can either be a cause for the development of the symptoms or can make the conditions worse.
Additionally, the specialist will prescribe certain medications based on the analysis of your skin. Your course of medication will be decided depending upon the severity of the symptoms.
Listed below are few of the most common treatment approaches based on the sternness of perioral dermatitis:
- In case of mild symptoms, children and pregnant women, the dermatologist generally advises individualized topical therapy. The affected individual may be prescribed medications such as:
- topical antibiotic medications, such as metronidazole (Metro gel) and erythromycin administered in non-greasy preparation.
- immunosuppressive creams, such as pimecrolimus or tacrolimus cream
- For the severe forms of perioral dermatitis, systemic treatment with drugs such as doxycycline (or tetracycline) and minocycline may be prescribed.
- In case of children with severe or refractory symptoms, oral erythromycin may be prescribed.
- In case of intolerance to cosmetics or steroid abuse, the doctor will recommend to stop use of all topical preparations and cosmetics. This is known as Zero-therapy wherein the treatment aims at eliminating the causative factor of perioral dermatitis.
- Initially in some cases, use of a low-potency corticosteroid such as hydrocortisone cream may be necessary.
Diet and lifestyle Alterations
In addition to the medicinal course, an essential segment of the perioral dermatitis treatment aims at implementing changes in the diet and lifestyle to prevent it.
A few of the necessary preventive measures include:
- Avoid using harsh face scrubs or perfumed soaps/cleansers. During flare-ups, get rid of any facial product and use only warm water. Once the symptoms alleviate, you may use a mild soap.
- Avoid steroid creams, including hydrocortisone, until they are prescribed by the dermatologist.
- Stop using or lessen the use of facial cosmetic products, sunscreens.
- Avoid spicy and overly salty foods that can aggravate the skin around the mouth.
How to prevent perioral dermatitis?
Since the cause of perioral dermatitis is not completely known, there isn’t a reliable approach to prevent it from occurring. However, there are some measures that you can follow to help alleviate it or to refrain the symptoms for worsening:
- Unless prescribed by your doctor, avoid the use of steroid creams and ointments. Usually, perioral dermatitis occurs because of strong topical steroids than weaker ones. So, you may use the weakest topical steroid to treat the ailment.
- Don’t use heavy cosmetics, makeup or skin creams. Consult your doctor for the appropriate moisturizers, if necessary. Try to choose another brand, if you wish to continue using cosmetics.
- Make use of gentle cleansers and moisturizers. Your dermatologist can recommendation the best suitable cleansers and moisturizers according to the skin condition.
- Restrict the exposure of skin to specific elements such as UV rays, heat, and wind. These elements can worsen perioral dermatitis. Some medications prescribed to treat perioral dermatitis are likely to make your skin sensitive to the sun. Ensure to safeguard your skin, in case you have to be outdoors for a long duration.
What is the long-term outlook?
It may be difficult to treat perioral dermatitis and can take even months to alleviate the symptoms. The initial course of treatment may worsen the condition before improving it. However, you must complete the treatment and must consult the doctor before stopping your medication.