Dermatitis perioralis literally means "inflammation of the skin around the mouth" (dermatitis = inflammation of the skin, perioralis = around the mouth). This condition is characterized by redness of the skin around the mouth with small pimples and pustules. It occurs mostly in young women and sometimes in children. A similar rash, *dermatitis periocularis*, can occur around the eyes.
How does dermatitis perioralis occur?
This dermatitis often results from the use of creams or ointments containing corticosteroids (adrenal bark hormones) on the face, commonly prescribed for conditions such as eczema. Stronger corticosteroids increase the risk of dermatitis perioralis, but even the weakest-acting hormone (hydrocortisone acetate) can be the cause. The use of corticosteroid preparations inhaled for asthma can also cause this condition.
There is not always a link to corticosteroids; sometimes cosmetics, especially foundation and other fat- or oil-containing makeup, play a role, and in some cases there is no obvious cause.
What are the symptoms?
Dermatitis perioralis usually develops suddenly on the upper lip, next to the nose or on the chin. The entire area around the mouth may be affected, with a narrow area of normal skin along the lips. The affected skin shows many small red pimples and pustules on a red and scaly surface. In dermatitis periocularis, similar abnormalities appear around the eyes and on the eyelids, which can closely resemble acne or rosacea.
In general, the condition itches slightly and the skin may be burning and sensitive. Contact with soap and exposure to sunlight may irritate.
Diagnosis and treatment
Diagnosis is usually made based on the characteristic abnormalities, with a biopsy usually not necessary. The main treatment is stopping the use of corticosteroid cream or ointment, as well as makeup. However, stopping the hormone cream may lead to a temporary worsening of the rash, but reuse of the cream should be avoided.
Dermatitis perioralis is often treated with a gel or cream containing metronidazole or erythromycin. Calcineurin inhibitors such as tacrolimus and pimecrolimus, which suppress the immune system in the skin, may also be used. Sometimes hydrocortisone cream is used temporarily to gradually discontinue stronger hormone creams. Antibiotics in tablet form, such as tetracycline, doxycycline or minocycline, are also prescribed. However, the use of some antibiotics may reduce the reliability of contraception.
Outlook
After healing, dermatitis perioralis usually does not recur. Local use of corticosteroids is not recommended to prevent recurrence.