Perioral/Periorificial Dermatitis

Perioral dermatitis is a chronic inflammatory facial dermatosis characterized by small red or flesh-colored bumps around the mouth. Because the nose and eye areas can also be affected, the broader term is periorbital dermatitis.

The condition can be confused with acne, allergies, eczema, or rosacea. Topical corticosteroids, especially those used on the face, can trigger or worsen the condition. A temporary rebound flare-up may occur when corticosteroids are discontinued.

The typical appearance is monomorphic papules around the mouth, sometimes pustules, dryness, fine scaling, burning or stinging. A thin strip of intact skin may remain just around the lip vermilion. The sides of the nose and around the eyes may be affected.

The exact cause is not fully known; barrier dysfunction, inflammation, triggers, and microbiome changes may all play a role. Numerous cosmetics/active ingredients, occlusive creams, and irritant care products can worsen symptoms. Contact products like toothpaste can be irritating in some individuals; it is not accurate to reduce the disease to a single component.

Comedones are typical in acne vulgaris; they are not expected in perioral dermatitis. Rosacea is an important differential diagnosis. It can also occur in children, and the granulomatous variant may be more common.

Diagnosis is mostly clinical. Treatment involves reducing triggers, appropriate discontinuation of unnecessary facial corticosteroids, simplifying skin care, and topical or systemic anti-inflammatory therapies in selected patients. Oral tetracyclines may be considered in more widespread disease; a significant portion of the current pharmacological evidence is of low/very low certainty.

Aggressive peeling and irritant procedures are not recommended during the active phase. Improvement may take weeks or months.