Perioral dermatitis (POD)

1 - ACKNOWLEDGEMENTS

Chapter written with the help of the EADV, the Fondation René Touraine and the Therapeutics in Dermatology

2 - OVERVIEW

Perioral dermatitis is a skin condition characterized by a rash around the mouth. This rash may also occur around the eyes, nose, or genitals, but this is much less common.

Perioral dermatitis is most common in females between the ages of 16 and 45 years. Older people, males, and children can also have the condition, although this happens less frequently. When perioral dermatitis affects children, it is called childhood perioral dermatitis.

3 - SYMPTOMS AND CLINICAL MANIFESTATIONS

As the name implies, the rash of perioral dermatitis develops around the mouth and in the folds around the nose, and usually tends to be red and slightly raised or scaly. The red spots may form a ring around the mouth, and usually appear a short-distance away from the lips. There may be a clear fluid discharge from the lesions.

Some people with perioral dermatitis may only get a few spots, therefore leading to a rash that may not be very discernible. However, others may have many pimples forming a noticeable rash. The spots may be skin colored, or, in people with fair skin, may appear red or pink. Although they might resemble pimples, this condition must be distinguished from acne.

The rash of perioral dermatitis may look inflamed, with the underlying and surrounding skin appearing red or pink. Itching or burning is usually mild, whereas pain is not a frequent symptom. Some people with perioral dermatitis may feel tightness, and the affected skin may be dry or flaky. Episodes of perioral dermatitis can last weeks or even months.

4 - CAUSES

The exact cause of perioral dermatitis is unknown, and there may be more than one contributing factor. One of the most common cause is prolonged use of topical corticosteroids or inhaled prescription steroid sprays used in the nose and mouth. Additional possible causes of perioral dermatitis include overuse of heavy face creams, moisturizers, make-up or toothpaste, defects in the skin’s protective barrier, a change in bacteria that colonize the skin, an allergic reaction, hormonal changes, taking birth control pills, and exposure to strong winds or UV light.

It is important to note that perioral dermatitis it is not contagious.

5 - TREATMENT

Perioral dermatitis is usually diagnosed by clinical examination, with no need for additional tests. As topical corticosteroids seem to be a primary causative factor for perioral dermatitis, it is essential to stop using them, as the continued use will cause the rash to worsen. Even over the counter hydrocortisone should be discontinued.

When a person stops using corticosteroids, the rash may get worse for days to weeks before it improves. It is vital not to be tempted to use corticosteroids again. If the rash does not get better on its own, then it is important to see a dermatologist.

The most reliable and effective treatment for perioral dermatitis is oral antibiotics. These are taken in decreasing doses for three to twelve weeks. Topical antibacterial creams and lotions may also be used for faster relief. These can be continued for several months in order to prevent recurrences. The dermatologist may also prescribe you a cream that suppresses the immune response.

Even after successful treatment, perioral dermatitis sometimes comes back later. In the majority of cases, the same treatment will be effective again. It is important to note that perioral dermatitis is a common skin problem, but with proper treatment most people do very well.

6 - TIPS FOR MANAGING

● Things you should do:

- avoid topical steroids

- wash the face with mild water and a mild soap or soap substitute

- using fragrance-free skin care products

- avoid sun exposure and strong winds

- limit overly salty or spicy foods, as they can irritate skin around the mouth

● Things you should not do:

- do not scrub the lesions

- do not use heavy creams (such as those that contain petrolatum or a paraffin base), moisturizers or make-up

- do not use fluorinated toothpaste

● When to see a doctor:

- perioral dermatitis usually clears up on its own in a few weeks once you stop using topical steroids; if it does not go away, then you should speak to your doctor.