The Picture of Perioral Dermatitis

Perioral dermatitis is a facial rash that tends to occur around the mouth. It can be mistaken for rosacea or even occur with rosacea. The picture of this facial redness often manifests as a red, slightly scaly or bumpy area around the mouth. Any itching or burning is mild. It may spread up around the nose, and occasionally the eyes while avoiding the skin adjacent to the lips. It is more common in women. Perioral dermatitis may come and go for months or years.

There may be more than one cause of perioral dermatitis. One of the most common factors is prolonged use of topical steroid creams and inhaled prescription steroid sprays used in the nose and the mouth. Overuse of heavy face creams and moisturizers also factor in the picture. Other causes include skin irritations, fluorinated toothpastes, and rosacea.

A dermatologist diagnoses perioral dermatitis by examination. No other tests are usually done. The first step in treating perioral dermatitis is to discontinue all topical steroid creams, even non-prescription hydrocortisone. Once the steroid cream is discontinued, the rash appears and feels worse for days to weeks before it starts to improve.(See the picture of Steroid Rosacea).
Heavy face creams should also be stopped. One must resist the temptation to apply any of these creams to the face when this happens. Think of the face as a cream junkie that needs a "fix"- one needs to go "cold-turkey".

A mild soap or soap substitute, such as Dove or Cetaphil should be used for washing. Scrubbing should be avoided. Try stopping fluorinated or tartar control toothpaste for stubborn cases. Non-fluorinated, non-tartar toothpaste is available at a health food store. The most reliably effective treatment is oral antibiotics. These are taken in decreasing doses for three to twelve weeks. Topical antibacterial creams and lotions may also be used for faster relief. These can be continued for several months in order to prevent recurrences.

Even after successful treatment, perioral dermatitis sometimes comes back later. Usually, the same type treatment will again be effective. Many cases that come back eventually turn into rosacea. Perioral dermatitis is a common skin problem, but fortunately most people do very well with proper treatment.

The Steroid Rosacea Picture

Steroid rosacea is the name given to a rosacea-like condition on the face caused by the use of potent topical steroids. It is a variant of perioral dermatitis (also known as periorificial dermatitis).

After several weeks of applying a topical steroid to the eyelids, cheeks or chin the affected area becomes red and inflamed. Small bumps (papules) and pustules appear intermittently, and may worsen to a severe state when the topical steroid cream is discontinued.

If the steroid creams are used for months or years, the picture changes and broken capillaries,(telangiectasia) may develop.


Occasionally steroid rosacea is confused with tinea facieiincognito, a fungal infection masked by topical steroids.


Steroid rosacea responds well to treatment in most cases although telangiectasia may persist long term.

The topical steroids should be discontinued. To minimise severe flare-up, slow withdrawal is recommended by decreasing how often the product is applied and choosing a product that is less potent.
If moisturisers are used, these should be non-oily.
Oral tetracycline is often prescribed and may be required for several months
The telangiectasia can be treated with a vascular laser.

How Green tea Figures in the Rosacea Picture

Green tea may be a safe and beneficial treatment for rosacea.
Now a cream made from an extract of freshly baked green tea leaves may be an effective treatment for a type of acne called papulopustular rosacea.
Women treated with the green tea extract cream had a 70% improvement in rosacea compared with women treated with a placebo says Tanweer Syed, MD, PhD, an associate professor of dermatology at the University of San Francisco, Calif., who developed the tea extract.
The study was presented at the American Academy of Dermatology meeting in New Orleans.
Typically, it starts with a tendency to blush -- rosy cheeks or redness and swelling in the center of the face which can progress to papulopustular rosacea.
Untreated, the condition can lead to chronic inflammation; the nose takes on the appearance of becoming red and enlarged.
Half of the women received the green tea extract cream and half received a placebo cream.
Clear, minimal or mild improvement of inflammation was seen in 70% of the women treated with the extract cream.
Syed says green tea extract cream was a natural choice for the rosacea because earlier research suggested that green tea extract has natural anti-aging and antiacne properties.
"The green tea has a soothing quality that helps the redness," Syed says.
The difference in this product versus others on the market, he says, is that the green tea leaves are picked and used within five hours, before turning dark and fermenting.
Guy Webster, MD, vice chairman of dermatology at Jefferson Medical College, Philadelphia, says the study involved only a small number of participants and more work needs to be done before the cream can be marketed.
Tanweer Syed, MD, PhD, associate professor of dermatology, University of San Francisco, Calif.

Source: http://my.webmd.com/content/article/101/106044.htm

Picture the Symptoms of Rosacea

The symptoms of rosacea can vary substantially from one patient to another, and may include various combinations of signs and symptoms. These symptoms of rosacea include facial redness or flushing; Telangiectasis also known as damaged or dilated facial blood vessels or spider veins; papules also described as a solid raised bump that may open when scratched, becoming crusty and infected; pustules which is a dome-shaped, fragile lesion containing pus that typically consists of a mixture of white blood cells, dead skin cells, and bacteria; skin sensitivity; a lumpy or orange-peel texture to the skin; facial swelling; burning sensations on the skin; ocular rosacea, often described as a red, irritated, gritty feeling in the eyes, the eyes may also have a swollen, watery appearance; the last symptom of rosacea is rhinopyma or nasal bumps that may produce a swollen misshapen appearance to the nose.

Studies suggest that eye (ocular) symptoms may occur in over half of rosacea patients, and 12 to 20 percent of ocular rosacea patients reported they developed their eye symptoms before developing any facial rosacea symptoms. On the other hand, facial redness is one of the most common symptoms of rosacea, and frequently appears before other signs and symptoms develop. Medical therapy can be tailored to control various signs and symptoms, and may also prevent rosacea from getting worse.