Dermatitis Perioralis - Eczeem Rond de Ogen Begrijpen en Behandelen

Differential Diagnosis

Acne vulgaris presents as inflammatory papules, pustules, cysts, and comedones primarily on the face, but may also affect the chest and back. Patients may have flares of acne secondary to mechanical mechanisms, such as from a helmet chin strap. The distribution of involvement may mimic perioral dermatitis. Adult female acne is characterized by inflammatory papules of the chin and jawline and can have a similar distribution as perioral dermatitis.

Seborrheic dermatitis presents as ill-defined erythematous patches with greasy scale distributed on the eyebrows, glabella, paranasal skin, nasolabial folds, beard, scalp, and chest.

Demodex folliculitis presents with scattered erythematous facial papules and pustules. Demodex mites have been implicated in the pathogenesis of rosacea. Unroofing of the pustules followed by microscopy of the purulent material shows numerous Demodex.

Tinea faciei presents with erythematous scaling papules and annular plaques and can be ruled out by performing a KOH prep and microscopic examination of the scale.

Syringomas and other cutaneous adnexal neoplasms also can mimic perioral dermatitis as these lesions are flesh-colored to erythematous facial papules. A biopsy is helpful for diagnosis.

Introduction

Perioral dermatitis is a benign eruption that occurs most commonly in young, female adults, consisting of small inflammatory papules and pustules or pink, scaly patches around the mouth. Although the perioral region is the most common area of distribution, this disease also can affect the periocular and paranasal skin. For this reason, it is often referred to as periorificial dermatitis. Topical steroid use to the face can trigger this, and therefore, a primary recommendation for treatment would be discontinuation of steroid application by the patient. Other treatment approaches include topical metronidazole, topical calcineurin inhibitors, and oral tetracycline antibiotics. Perioral dermatitis often responds readily to therapy but can be chronic and recurrent.

The exact cause of perioral dermatitis is unknown. It has multiple environmental exposures linked to its etiology. For some patients, there is an association between topical corticosteroid use and perioral dermatitis.[1] Topical steroid use may precede the eruption, and chronic use of topical steroids increases the risk of developing severe disease.[2] Initially, the facial eruption is responsive to the use of the topical steroid. However, upon withdrawal of the topical steroid, the eruption recurs. This leads to long-term dependency on topical steroid use.[3] Eventually, perioral dermatitis may progress in severity with chronic steroid use and may evolve into a granulomatous subtype of the disease. In addition to topical steroid use, perioral dermatitis has been reported to occur with the use of nasal and inhaled corticosteroids.[4][5] The exact mechanism through which topical steroids predispose patients to perioral dermatitis is not understood. It has been postulated that topical steroids influence the microflora of the hair follicle, which may contribute to the pathogenesis of this condition.[6][7][8] Some investigators have proposed infectious sources as a cause for perioral dermatitis, including Candida albicans, fusiform bacteria, and Demodex mites.[6][7][8] Fluorinated toothpaste use has also been associated with perioral dermatitis.[9] Additionally, chewing gum and dental fillings have been associated with perioral dermatitis.[10][11] Certain cosmetic products, such as combined use of moisturizers and foundations, as well as physical sunscreens, have been etiologic in some patients.[12][13] Given the female predominance with this condition, hormonal factors have been considered in the etiology. Interestingly, oral contraceptive pills have been associated with the improvement of perioral dermatitis.[14]

Treatment Options

PD may go away on its own, but it depends on the cause. If you use a steroid cream or spray, your healthcare provider may recommend that you stop doing so as a first step. It's important to note that the rash may get worse before healing. Use a gentle facial soap while your rash heals.

Symptoms may resolve if you limit exposures (like mask-wearing or fluoride toothpaste) or correct a zinc deficiency. But it's possible that discontinuing the use of products like sunscreen may not be enough to clear the rash in a matter of days.

A Word From Verywell

It can take time for perioral dermatitis to improve, even when using the proper treatments, so it's important to be patient when treating the condition. It's also important to remember that it can recur, so even once it is improved, it may be necessary to continue the treatments for a period of time to help maintain it and prevent it from recurring.

Prescription Medications

In some cases, prescription medications may be recommended. The most commonly prescribed medication is an antibiotic, and it may be used for weeks to months.

Topical antibiotics are common (such as an erythromycin gel or metronidazole) and they can be used in moderate to severe cases along with oral antibiotics like tetracycline or doxycycline.

Elidel topical cream, a medication commonly used for an eczema rash, also is an option.

Perioral dermatitis can recur, even with treatment. You may go through periods of flare-up and periods where you have no symptoms. For some patients, long-term management of the condition may be necessary.