Generality
Perioral dermatitis is a skin inflammation that affects the area around the mouth .
This pathology appears as an erythematous eruption, characterized by small papules and dry skin . In some respects, perioral dermatitis is similar to acne and / or rosacea, but differs from these conditions, respectively, due to the absence of comedones and the location of lesions.
The causes triggering perioral dermatitis are not yet fully known, but a close correlation has been found with the prolonged application of topical corticosteroids and the use of cosmetics containing potentially irritating substances.
The management of perioral dermatitis consists of a systemic and / or topical drug therapy, in combination with the prevention of trigger factors.
What's this
What is Perioral Dermatitis?
Perioral dermatitis is an erythematous, papulo-pustular rash, similar to acne and / or rosacea.
As can be guessed from the term "perioral", this form of dermatitis typically begins around the mouth .
Perioral dermatitis is observed mainly in women.
Causes and Risk Factors
What are the causes of Perioral Dermatitis?
The pathophysiological mechanism underlying perioral dermatitis is unknown. The origin of the disorder is inflammatory in nature, but it has not yet been well understood why this response arises and concentrates in the region around the mouth. Perioral dermatitis is limited to the skin.
One of the hypotheses put forward suggests that the long-term use of certain substances, such as topical corticosteroids and some cosmetics, are capable of inducing small alterations in the structure of the facial skin. This could make the skin surface more vulnerable to environmental factors (wind, cold, sunlight etc.) or other potential irritants .
According to other scientific sources, perioral dermatitis could be of neurogenic origin: some nerve cells locally, would release pro-inflammatory substances helping to trigger the skin rash. Other proposed mechanisms relate to the overgrowth of some microorganisms on the skin.
Perioral Dermatitis: predisposing factors
As anticipated, the causes of perioral dermatitis have not yet been defined with certainty. However, some factors have been identified that can contribute more to the onset of the disorder: more often than not, at the base of the problem, there is not a single responsible mechanism, but a set of contributing factors capable of inducing the barrier dysfunction epidermal and activation of the immune system, from which inflammation results .
The most accredited factors that trigger perioral dermatitis include:
- Topical corticosteroids (creams, ointments and gels): excessive and prolonged use of these drugs is related to the onset of perioral dermatitis, but it is not clear what the correlation is between the risk of developing inflammation and the concentration of the drug the duration of the treatment. Perioral dermatitis has also been reported after the use of corticosteroid-based inhalers and nasal sprays.
- Fluoride toothpastes .
Potential risk factors also include the use of poor quality cosmetic products for skin care (moisturizers, physical or detergent sunscreens) and / or containing irritants, such as sodium lauryl sulfate (SLS), isopropyl myristate, Vaseline and paraffin.
Furthermore, at the onset of perioral dermatitis:
- Hormonal imbalances : perioral dermatitis may worsen in the period preceding the onset of menstruation;
- Contraceptive pill ;
- Infectious agents of various nature and altered cutaneous microflora (eg Bacillus fusiformis, Demodex folliculorum and Candida albicans );
- Intestinal disorders (eg malabsorption of various nature, positivity for Helicobacter pylori );
- Particular climatic factors, such as exposure to strong wind, heat or ultraviolet rays;
- Stress and mood swings .
Perioral dermatitis: who is most affected?
Perioral dermatitis is a typically female disorder; this inflammation mainly affects women aged between 20 and 45 years .
Less often, however, perioral dermatitis affects children and men.
Symptoms and Complications
Perioral dermatitis: how does it manifest itself?
- Redness and papules
Perioral dermatitis is characterized by an eruption of papules (small skin reliefs) of an erythematous nature . These signs begin at the level of the nasolabial folds and, subsequently, tend to extend around the mouth and can also involve the chin and part of the cheeks . Perioral dermatitis, on the other hand, spares the lip contour area (ie the so-called vermilion), just as the inner part of the mouth is not affected by inflammation.
Erythematous papules are similar to those that occur when you have acne. Less often, the rash of perioral dermatitis consists of pustules and papulo-vesicles (lesions with serous or purulent contents).
- itch
The onset of true erythema can be anticipated by an itchy sensation . This may represent one of the initial symptoms of perioral dermatitis, but it is not always present.
- Dryness of the affected area, with or without flaking
In the area of the chin, of the nose-genius furrows and of the labial filter (between the upper lip and the nose), reddish spots can appear with clear borders . These signs of perioral dermatitis appear to be dehydrated and finely scaled . Furthermore, these red and dry patches are associated with burning, itching or tenderness sensations.
Variants of Perioral Dermatitis
The rash that characterizes the perioral dermatitis can also spread to the forehead, to the cheekbones and in the periorbitaria region.
Perioral Dermatitis: What can exacerbate or worsen symptoms?
Topical corticosteroids worsen the symptoms of perioral dermatitis, so contact of the area around the mouth with hot or cold foods and direct exposure to the sun, wind and low temperatures can be annoying. Infections can complicate this picture.
Diagnosis
Perioral dermatitis: how is it diagnosed?
Perioral dermatitis is diagnosed by the primary care physician or dermatologist, after a thorough examination of the area affected by the rash and the analysis of risk factors.
During the physical examination, the primary care physician or the dermatologist can recognize an inflammation of this type with the observation of the skin.
At the moment, there are no specific tests that are useful in the conclusive diagnosis of perioral dermatitis. However, the doctor can indicate the execution of other investigations, to try to trace the cause that originated it or to exclude other dermatological pathologies that have a similar presentation.
Perioral dermatitis: differential diagnosis
Perioral dermatitis differs from acne due to the absence of blackheads and from rosacea due to the lack of lesions around the mouth and eyes.
The differential diagnosis should exclude seborrheic and contact dermatitis .
Treatment and Remedies
From the therapeutic point of view, perioral dermatitis is usually difficult to manage, since at the base there is not a single cause, but a mix of different factors. For this reason, it is necessary to act on several fronts, with a treatment plan that often takes a few months.
First useful measures
Usually, the first approach to perioral dermatitis involves the suspension of topical corticosteroids if used. The same intervention is useful for what has an irritating capacity, such as facial cosmetics (moisturizers, cleansers, etc.) that were previously applied to the affected area.
To avoid that the perioral dermatitis can recur, then, it is useful to continue for a certain period with the suspension of these products, even when the problem is solved. At the same time, it is advisable to avoid exposure to the sun as much as possible, since UV rays make the situation worse.
Drugs and other therapeutic interventions
In the event that perioral dermatitis is sustained by a bacterial infection, drug therapy involves the use of antibiotics:
- Topical, ie to be applied topically, such as erythromycin or metronidazole;
- Orally, like tetracyclines.
When perioral dermatitis depends on hormonal dysfunction, it will be necessary to intervene, from an endocrinological point of view, to restore balance.
In certain cases of perioral dermatitis, especially the more serious ones, there are some treatments that can give good results; if you consider them indicated, the doctor will advise them.
These include:
- Isotretinoin : it is effective in particularly resistant cases of perioral dermatitis, as it counteracts the production of substances responsible for the lesions typical of the pathology. This drug should be taken orally in the form of tablets. The use of isotretinoin is contraindicated in pregnancy.
- Pimecrolimus: it is a valid remedy especially for the irritation caused by the application of steroidal ointments; helps to significantly reduce the inflammatory state of the skin.
- Benzoyl dioxide : it may be useful, but in some cases it can worsen the dryness of the skin.
Photodynamic therapy may also be useful in the treatment of perioral dermatitis .
Remedies
As for natural and home remedies, it is possible to attenuate the redness of perioral dermatitis by applying cold packs of chamomile infusion .
Some advice
- Once the problem has been solved, to prevent it from recurring it is best to avoid applying cosmetics to the perioral area that contain potentially irritating substances such as paraffin, vaseline, isopropyl myristate and sodium lauryl sulfate.
- If identified during the diagnostic procedure, avoid individual trigger factors.
- To wash the face, use only warm-warm water until perioral dermatitis is present.
Prognosis
Perioral dermatitis is not a serious or life-threatening disease. However, this pathology tends to be chronic and can require an unexpectedly long treatment period, to obtain a satisfactory skin condition from an aesthetic point of view.
Prevention
Although the causes of perioral dermatitis are not yet fully understood, some measures may be useful for prevention.
These include:
- Avoid long-term use of topical corticosteroids, except in cases where they are prescribed by a doctor, for the treatment of a dermatosis;
- Use sunscreens in fluid formulation or gel;
- Do not clean the face with soap: its alkalinity and its ability to deposit carbonate salts can irritate the skin. At resolution, it is better to use delicate detergent products.
