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

• PD (Periorificial Dermatitis)

What is Periorificial Dermatitis? (Definition/Background Information)

• Periorificial Dermatitis (PD) is a common skin condition of generally unknown cause. It is characterized by the presence of multiple itchy papules and pustules in the skin around the mouth, nose, and eyes. Many cases are observed in young and middle-aged women
• Based on the location of the lesions, Periorificial Dermatitis may be categorized as:
  • Perioral dermatitis - involving the skin areas around the mouth
  • Periocular dermatitis - involving the eyelids and areas around the eye
  • Genital Periorificial Dermatitis, which affects the genitalia in both males and females
• Periorificial Dermatitis can result in redness of skin, scaly skin, and itchiness in the affected region. The risk factors identified for the condition include the use of steroidal medications, hormonal factors, and use of certain cosmetics
• The treatment for Periorificial Dermatitis may include the use of topical creams and antibiotics. The prognosis is excellent in most individuals with appropriate therapy. However, the condition is known to recur even after a few years following the completion of treatment

Who gets Periorificial Dermatitis? (Age and Sex Distribution)

• Periorificial Dermatitis is a common skin condition that is mostly seen between the ages of 15 and 50 years. However, the condition may be also noted in children
• It can affect both males and females, but there is a predilection for females (typically women)
• The condition can occur worldwide; individuals of all racial and ethnic background may be affected

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

The risk factors for Periorificial Dermatitis may include:

• Use of certain medications, such as topical steroidal applications, or inhaled/nasal steroids
• Use of OTC steroidal creams
• Certain hormonal factors including the use of oral contraceptives
• Use of cosmetics, including sunscreen lotions
• Poor hygiene, particularly involving the face (i.e., not washing the face regularly)
• Toothpastes containing fluorides
• 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 one’s 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 Periorificial Dermatitis? (Etiology)

The cause of development of Periorificial Dermatitis is unknown. The condition is not known to be caused by any infections.

• In many individuals, it occurs after the use of topical steroids; the steroidal creams may have been prescribed for other skin conditions
• Research experts believe that some of the following factors may be involved:
  • Dysfunction of the skin barrier (epidermis/stratum corneum)
  • Abnormal activation of the body’s immune system
  • Changes in the naturally residing skin microorganisms
  • Bacteria thriving in the hair follicles

What are the Signs and Symptoms of Periorificial Dermatitis?

In some individuals, Periorificial Dermatitis may be asymptomatic or only mild signs and symptoms are observed. In others, the signs and symptoms may include:

• The presence of 1-2 mm multiple red papules and pustules
• The lesions may be observed in clusters
• The skin around the mouth, nose, and eyes are usually involved. However, the borders around the eyelids, nostrils, and lips may be spared
• Also, the cheeks and forehead may not present any lesions
• The skin can be dry and flaky
• The papules and pustules may sting, burn, and itch
• The skin symptoms can last for weeks to months

How is Periorificial Dermatitis Diagnosed?

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

• A thorough physical examination and a complete medical history are important
• Assessment of presenting signs and symptoms
• Dermoscopy: Dermoscopy is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Culture studies may be performed to rule out a bacterial infection
• A skin tissue biopsy is not usually needed to diagnose Periorificial Dermatitis

A differential diagnosis may be undertaken to eliminate other skin conditions such as:

• Allergic contact dermatitis
• Dermatomyositis
• Seborrheic dermatitis
• Steroid-induced rosacea

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 Periorificial Dermatitis?

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

• Emotional stress due to cosmetic concerns
• Chronic itching and scaling of the skin may cause the skin to become thick, discolored, and leathery
• Bacterial and fungal infections: If it causes continuous itching and scaling of the skin, it can result in moist skin, which provides a suitable environment for secondary infections
• Development of granulomatous Periorificial Dermatitis in children, which is a persistent condition
• Rarely, a sudden stoppage of topical steroid creams may result in flaring up of Periorificial Dermatitis with severe symptoms

Periorificial Dermatitis may recur even after complete disappearance of the signs and symptoms.

How is Periorificial Dermatitis Treated?

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

• The healthcare provider will recommend a slow stoppage or tapering of the strengths of steroidal topical applications and nasal inhalations (if being used earlier by the patient)
• Informing the patient that if they had been using topical steroids, the condition will inevitably flare on the necessary stoppage thereof, and not to return to the use of them for temporary relief
• For mild skin conditions, self-care measures, such as washing with mild (antibacterial) soap and applying warm compress, are recommended
• Topical creams such as erythromycin, clindamycin, metronidazole, azelaic acid, and pimecrolimus
• Anti-inflammatory oral medications, if necessary
• 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.

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

• Completely avoid scratching the affected areas (keep fingernails trimmed)
• A comfortable, cool bath may help soothe the skin; but, avoid excessive washing and scrubbing of the skin
• Use only mild perfumes and soaps
• Keeping the skin moist can help in reducing the signs and symptoms

Taking care of oneself, being clean and hygienic, 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 Periorificial Dermatitis be Prevented?

Currently, it may be difficult to prevent the onset of Periorificial Dermatitis in some cases. In others, the following may be considered:

• Avoiding the use of non-prescription topical steroids
• Not using high potency topical steroids on the face
• In case topical steroids are prescribed by the physician, then closely following instructions for using the medication/application and only for the duration of the prescription period
• Avoiding face cosmetics and sunscreens that block the sweat glands (occlusive creams)

Individuals with Periorificial Dermatitis may aggravate the existing condition by continuing to use nasal/topical steroids and cosmetic make-ups and creams.

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

• The prognosis of Periorificial Dermatitis is excellent with appropriate treatment as the condition is known to respond well to suitable therapy
• Nevertheless, the condition may recur after complete resolution of symptoms following treatment, sometimes months/years after it ceased

Additional and Relevant Useful Information for Periorificial 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 Periorificial Dermatitis. However, it helps to be clean and hygienic, which will help the condition from getting worse