What are the other Names for this Condition? (Also known as/Synonyms)

• POD (Perioral Dermatitis)

What is Perioral Dermatitis? (Definition/Background Information)

• Perioral Dermatitis (POD) is a common skin condition of generally unknown cause. It is characterized by the presence of multiple papules and pustules in the skin around the mouth, nose, and eyes
• This can result in redness of skin, scaly skin, and itchiness in some cases. However, Perioral Dermatitis does not cause significant complications, but is known to recur even after a complete resolution of symptoms
• Older children, young and middle-aged adults are commonly affected by Perioral Dermatitis. The risk factors identified for the condition include the use of certain medications, hormonal factors, and autoimmune disorders
• The treatment for Perioral Dermatitis may include the use of topical creams and moisturizers, antibiotics, and laser surgery for cosmetic issues. The use of moderate to strong steroid creams is known to worsen the condition
• The prognosis of Perioral Dermatitis is excellent with appropriate treatment. However, the condition is known to recur even after a few years following successful (initial) treatment

Who gets Perioral Dermatitis? (Age and Sex Distribution)

• Perioral Dermatitis is a common skin disorder that usually occurs between the ages of 15 and 50 years
• It can affect both males and females, though there is a predilection for females
• The condition can occur worldwide; individuals of all racial and ethnic background may be affected

What are the Risk Factors for Perioral Dermatitis? (Predisposing Factors)

The risk factors for Perioral Dermatitis include:

• Lip licking
• Use of lipstick
• Certain medications
• Oral care products
• Certain hormonal factors
• Autoimmune disorders

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Perioral Dermatitis? (Etiology)

Presently, the exact cause of Perioral Dermatitis development is not well-understood.

• In many individuals, it occurs after the use of steroids in the affected area; the steroid creams may have been prescribed for some other skin condition
• Mildest steroid creams used for short durations are usually tolerated. However, stronger steroids and longer durations are likely to trigger Perioral Dermatitis
• There is no definitive proof that certain types of diet play a role in the development of this skin condition

Perioral Dermatitis is not contagious and does not spread from one individual to another. In other words, one cannot contract the condition by interacting closely with an affected individual.

What are the Signs and Symptoms of Perioral Dermatitis?

In many individuals, Perioral Dermatitis is asymptomatic or mild; no signs and symptoms are frequently observed. In others, the features of Perioral Dermatitis may include:

• The presence of 1-2 mm multiple papules and pustules on the face; the skin lesions are symmetrically present on the face
• The skin is red in the affected areas (facial rashes); the skin can be dry and flaky
• In some, the papules and pustules may sting and burn; they may also itch
• Even though the condition is called perioral (around the mouth), the lesions may form around the eyes (called periorbital), nose (called perinasal), or on the forehead
• Rarely, such skin lesions can occur around the genitalia too
• The skin symptoms can last for weeks to months

It is difficult to predict who gets mild or severe symptoms.

How is Perioral Dermatitis Diagnosed?

The following are the diagnostic methods that may be used for Perioral Dermatitis:

• A thorough physical examination and a complete medical history are very crucial. A diagnosis of Perioral Dermatitis is clinically arrived at by analyzing the classical signs and symptoms of the condition
• Dermoscopy: Dermoscopy is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Culture studies may be performed to rule out a bacterial infection
• A tissue biopsy is not usually needed to diagnose Perioral Dermatitis

A differential diagnosis may be undertaken to eliminate other skin disorders and these may include:

• Allergic contact dermatitis
• Steroid acne
• Lupus
• Seborrheic dermatitis
• Dermatomyositis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Perioral Dermatitis?

No significant complications due to Perioral Dermatitis have been reported. If the condition is severe, then the following complications may be observed:

• Chronic itching and scaling of the skin may cause the skin to become thick, discolored, and leathery
• Bacterial and fungal infections: If Perioral Dermatitis causes continuous itching and scaling of the skin, it can result in moist skin, which provides a suitable environment for secondary infections
• The presence of skin infections and scarred skin on the face can cause self-image issues (cosmetic concerns), emotional and psychological stress
• In some cases, Perioral Dermatitis may lead on to become rosacea (a chronic skin condition affecting the sweat glands and hair follicles)

Perioral Dermatitis tends to recur even after complete disappearance of the signs and symptoms.

How is Perioral Dermatitis Treated?

Treatment strategies that may be adopted in the management of Perioral Dermatitis include:

• For mild skin conditions, certain self-care measures are recommended, such as washing with mild (antibacterial) soap and applying soothing compresses
• Topical creams and antibiotics
• Oral antibiotics
• Laser excisional surgery to address cosmetic concerns
• Follow-up care with regular screening and checkups are important

If any of the prescribed treatment medication or methods cause new stinging or burning symptoms, then it is important to discontinue the medication or method and immediately inform the healthcare provider.

Note: On the use of steroidal creams.

• In many cases, the condition is misdiagnosed as contact dermatitis or seborrheic dermatitis for which topical steroid creams are generally prescribed. This often worsens Perioral Dermatitis
• In many, for unknown reasons, the condition gets worse for a few days to weeks after stopping the steroid creams and applications, before getting better. During this period, one must resist the temptation to use steroidal creams again

A few self-care tips and home remedies for Perioral Dermatitis may include:

• Completely avoid scratching the affected areas (keep nails trimmed)
• A comfortable and cool bath may help soothe the skin; but, avoid excessive washing and scrubbing of the skin
• Wear smooth cotton clothes
• Use only mild perfumes, soaps, and detergents
• Keeping the skin moist can help in reducing the signs and symptoms caused by Perioral Dermatitis

Taking care of oneself, being clean and hygienic (especially face and hands), avoiding the urge to touch/break the blisters, avoiding oily make-ups and creams, drinking lots of water, etc. are all simple practices that can ensure a faster recovery from the condition.

How can Perioral Dermatitis be Prevented?

Currently, there are no specific methods or guidelines to prevent the onset of Perioral Dermatitis. However, the following factors are known to aggravate the condition and should be avoided:

• Use of certain types of sunscreens in some individuals
• Not maintaining good facial hygiene
• Use of oral contraceptives
• Topical steroid creams
• Use of nasal sprays
• Fluorine-based toothpaste, in some cases

Also, if Perioral Dermatitis is due to the presence of an underlying disorder, then undertaking suitable treatment of the condition may reduce the risk for the skin disorder.

What is the Prognosis of Perioral Dermatitis? (Outcomes/Resolutions)

• The prognosis of Perioral Dermatitis is generally excellent with appropriate treatment
• Nevertheless, the condition may recur after complete resolution of the symptoms, sometimes months/years after it ceased
• Regular follow up visits with the healthcare providers are important and recommended

Additional and Relevant Useful Information for Perioral Dermatitis:

• Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition
• The presence of dirt on the body is not a causative factor for Perioral Dermatitis. However, it helps to be clean and hygienic, which will help the condition from getting worse