Periorificial dermatitis

Author: Reviewed and updated by Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand; Vanessa Ngan, Staff Writer, February 2014. Further updated in January 2016.

What is periorificial dermatitis?

Periorificial dermatitis is a common facial skin problem characterised by groups of itchy or tender small red papules. It is given this name because the papules occur around the eyes, the nostrils, the mouth and occasionally, the genitals.

The more restrictive term, perioral dermatitis, is often used when the eruption is confined to the skin in the lower half of the face, particularly around the mouth. Periocular dermatitis may be used to describe the rash affecting the eyelids.

See more images of perioral, periocular and periorificial dermatitis ...

Who gets periorificial dermatitis?

Periorificial dermatitis and its variants mainly affect adult women aged 15 to 45 years. It is less common in men. It may affect children of any age.

People with periorificial dermatitis are often using topical or inhaled corticosteroids.

What is the cause of periorificial or periorificial dermatitis?

The exact cause of periorificial is not understood. Periorificial dermatitis may be related to:

Unlike seborrhoeic dermatitis, which can affect similar areas of the face, malassezia yeasts are not involved in periorificial dermatitis.

Periorificial dermatitis may be induced by:

What are the clinical features of periorificial dermatitis?

The characteristics of facial periorificial dermatitis are:

In contrast to steroid-induced rosacea, periorificial dermatitis spares the cheeks and forehead.

Genital periorificial dermatitis has a similar clinical appearance. It involves the skin on and around labia majora (in females), scrotum (in males) and anus.

Complications of periorificial dermatitis

Granulomatous periorificial dermatitis is a variant of periorificial dermatitis that presents with persistent yellowish papules. It occurs mainly in young children and nearly always follows the use of a corticosteroid. There is a granulomatous perifollicular infiltrate on histopathology.

Steroid rosacea presents with steroid-induced, large facial papules, papulopustules and telangiectasia on the mid-face, including forehead and cheeks.

Rebound flare of severe periorificial dermatitis may occur after abrupt cessation of application of potent topical steroid to facial skin.

How is periorificial dermatitis diagnosed?

The presentation of periorificial dermatitis is usually typical, so clinical diagnosis is usually straightforward. There are no specific tests.

Skin biopsy shows follicular and perivascular chronic inflammation similar to rosacea.

What is the treatment for perioral dermatitis?

Periorificial dermatitis responds well to treatment, although it may take several weeks before there is noticeable improvement.

General measures

Topical therapy

Topical therapy is used to treat mild periorificial dermatitis. Choices include:

Oral therapy

In more severe cases, a course of oral antibiotics may be prescribed for 6–12 weeks.

How can periorificial dermatitis be prevented?

Periorificial dermatitis can generally be prevented by the avoidance of topical steroids and occlusive face creams. When topical steroids are necessary to treat an inflammatory facial rash, they should be applied accurately to the affected area, no more than once daily in the lowest effective potency, and discontinued as soon as the rash responds.

What is the outlook for periorificial dermatitis?

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

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