The Rosacea - Perioral Picture

Often mistaken for rosacea and sometimes occurring with rosacea, Perioral dermatitis is a common facial skin problem in adult women. It rarely occurs in men. Groups of itchy or tender small red spots appear most often around the mouth. They spare the skin bordering the lips (which then appears pale) but develop on the chin, upper lip and cheeks. The skin surface becomes dry and flaky.

Often the skin around the nose is affected too, and sometimes that around the eyes (when it should more correctly be called ‘periocular’, or better still, ‘periorificial’ dermatitis.)

Patients who are susceptible to perioral dermatitis tend to have an oily face, at least in the affected areas.

Perioral dermatitis is probably induced by:

Neglecting to wash the face with soap or preferably a soap-free cleanser and water.

Applying face creams regularly to the area bounded by the cheek folds and chin, or around the eyes in the case of periocular dermatitis. These creams include moisturizers, cream cleansers, make-up foundation, acne medications and sunscreens.

Applying topical steroid creams to the same area. The more potent the steroid cream, the more rapid and severe the perioral dermatitis which may result.

The reason why perioral dermatitis arises is unknown. Recent research suggests it may be related to proliferating bacteria in the hair follicles.

Luckily perioral dermatitis responds well to treatment. Discontinue applying all face creams including topical steroids, cosmetics and sunscreens.

Note: when a steroid cream is discontinued, the rash gets worse for a few days before it starts to improve. Do not apply face creams in the affected areas in the future, as the rash is very likely to reappear. Choose a liquid, gel or light milk sunscreen. Wash the face with warm water alone while the rash is present. When it has cleared up, wash with a non-soap bar or cleanser and water. Your doctor or dermatologist will usually also prescribe a course of oral antibiotics for six to twelve weeks. Normally tetracycline or one of its derivatives is recommended. Antibiotic lotions tend to be less effective.

Perioral dermatitis sometimes recurs when the antibiotics are discontinued, or at a later date. The same treatment can be taken again.

Perioral dermatitis may be aggravated by toothpaste containing tartar-control or fluoride additives, mouthwashes or even some chapsticks.