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Perioral Dermatitis: Be ready for those memorable holiday photos

As we celebrate the holidays and enjoy the company of family and friends, our face and appearance is important to us. Seasonal and other environmental changes can lead to certain skin conditions and perioral dermatitis is no exception this holiday season. Perioral dermatitis is a condition that affects the areas around the nose, mouth, and less often even around the eyes ( periocular or periorificial dermatitis). It is an inflammatory skin rash characterized by redness, scale, pimples, and pustules. Symptoms may include only the apparent rash or also itch, pain, and tenderness. It is unclear why perioral dermatitis occurs. Men, women, and children can be affected with a predominance of women seeking dermatologic care. Topical corticosteriod use found in creams, eye drops, or nasal inhalers can lead to perioral dermatitis and other acne-like eruptions on the face. Other contributors to perioral dermatitis include changes in menstrual cycles, fluorinated tootpastes, changes in seasons, use of new topical facial products, and head gear with face or chin straps worn by athletes. The facial rash of perioral dermatitis can be quite disfiguring and is usually noticeable to others. If left untreated, ongoing inflammation may lead to acne-like scarring in the affected areas and prolonged skin discoloration.

Perioral Dermatitis

What may mimic perioral dermatitis?

Given the pimples and pustules, perioral dematitis can resemble an abrupt acne flare. It can also overlap with rosacea since it has some redness and pimples on exam. Seborreic dermatitis, another inflammatory condition that can cause redness and scale around the eyes, nose, and mouth folds may also be confused with perioral dermatitis. Individuals who are prone to eczema and hypersensitivity reactions also seem more prone to perioral dermatitis and the two conditions may overlap. Impetigo ( a skin bacterial infection) is common in children and may also resemble non-infectious perioral dermatitis but typically involves honey-colored crusting and weeping of the affected area around the mouth and nose.

How to treat perioral dermatitis?

For some perioral dermatitis can persist for months before improving gradually spontaneously, especially if aggravators are removed or exacerbating conditions resolve. However, most cases need some form of anti-inflammatory intervention with topical medications or oral antibiotics. Topical antibiotics such as clindamycin or erythromycin can help improve surface pustules. Elidel cream, a non-steroid topical medication FDA--approved for eczema can improve the redness, scale, and symptoms associated with the rash. Oral tetracyclines are the mainstay treatment for refractory perioral dermatitis and are typically administered for about six to eight weeks.

What to expect?

Perioral dermatitis may be a one-time occurrence or may be a episodic condition that flares seasonally or every several years. Treating the condition for the entire recommended duration can help minimize relapse. If you are dealing with persistent facial rash, please see a dermatologist or your healthcare provider to determine how to best diagnose and treat the condition.

Margareth Pierre-Louis