perioral dermatitis; periorificial dermatitis

Etiology

• associated with use of potent topical steroids
  • prolonged glucocorticoid therapy for atopic dermatitis
  • inappropriate use of topical glucocorticoids to treat acne
• zinc deficiency
• idiopathic (unknown)

Epidemiology

• age 20-30 & may occur in children
• predominantly disorder of young women

Clinical manifestations

• papulopustules on an erythematous background (acneiform)
  • small (< 2 mm) papules & pustules around the mouth or eyelids
• papules often become confluent forming inflammatory plaques
• lesions of weeks to months duration
• perioral distribution of lesions
  • generally spares skin around lips
• periorbital lesions less common
• resembles acne
• no comedones

* images

Laboratory

• culture for Staphylococcus aureus

Differential diagnosis

• allergic contact dermatitis
• atopic dermatitis
• seborrheic dermatitis
• rosacea
• acne vulgaris
• steroid acne

Management

• topical antibiotics
  • metronidazole 0.75% gel or cream BID
  • erythromycin 2.0% gel BID
• systemic antibiotics
  • minocycline or doxycycline
    • 100 mg PO BID until clear, then
    • 100 mg QD for 1 month, then
    • 50 mg QD for an additional month
  • tetracycline
    • 500 mg BID until clear
    • 500 mg QD for 1 month
    • 250 mg QD for an additional month
• avoid corticosteroids - may be markedly aggravated by fluorinated corticosteroids

More general terms

• sebaceous gland disease
• acneiform eruption