Perioral dermatitis
What can you find on this page about a clown eczema
- Wat is perioral dermatitis?
- How can you get perioral dermatitis?
- Around the mouth
- Around the eyes
- Causes of perioral dermatitis
- Do you get perioral dermatitis from certain foods
- Who can suffer from perioral dermatitis
- Perioral dermatitis with a baby
- Perioral dermatitis with a child
- Perioral dermatitis with woman
- How do you treat perioral dermatitis?
- Tips on perioral dermatitis
- Which Iconic Elements products are recommended if you suffer from perioral dermatitis
Dr Francis Wu on perioral dermatitis
Below, Dr. Francis Wu briefly about the complaints, causes and tips for perioral dermatitis
The name Dutch name for perioral dermatitis is clowns eczema and says it all. It is a benign and non-contagious skin condition and can be recognized by the small inflammatory papules and pustules and/or red/pink scaly fields. The bumps are not real pimples, they are eczema bumps, filled with fluid.
In this condition, the area around the mouth (periorale) or around the eyes (periocularis) is affected. It is striking that the area immediately around the lip red is not affected. However, the skin abnormalities can also occur on either side of the nose.
Sometimes the forehead, eyelids and between the eyebrows are also affected. The papules often develop in attacks and cause irritation such as itching and burning. The complaints can be aggravated by soap, sunlight, and even contact with water.
In most cases, the diagnosis is made with a trained eye. And if tissue research is done, also called a biopsy (histological examination), a mild non-specific inflammation becomes visible. The inflammations differ between perivascular (around the vessels) and peri-follicular (around the follicle).
The exact cause of perioral dermatitis is still unknown.
The use of corticosteroids in the face may be a trigger for the condition. The stronger the hormone works, the greater the chance of developing perioral dermatitis, but sometimes the weakest active hormone (hydrocortisone acetate) can also be the cause. More about how to properly apply a hormone ointment?
It is still uncertain how topical corticosteroids can lead to perioral dermatitis, but damage to the microorganisms in the hair follicles is thought to play a role. There are harmless bacteria on the skin that form a natural barrier together with the skin. When that skin barrier is broken, intruders can enter the skin more quickly. No bacterial causative agent of perioral dermatitis has ever been cultured.
In addition to corticosteroids, there is a very long list of possible causes. This list ranges from medication, cosmetics and dental fillings to weather changes and even chewing gum and toothpastes with a high fluoride content (Colgate duraphat 5000 plus/Colgate maximum cavity protection). So many things could be a possible cause.
Hormonal factors can also trigger perioral dermatitis in women during the premenstrual period, during pregnancy and when using oral contraception or the Mirena IUD.
What ingredients should I avoid and where can I find them?
- Parabens: these extend the shelf life of products, but are very damaging to the skin. Among other things, they inhibit the growth of fungi and bacteria, so that they can influence your own skin microbiome.
- Phenoxethanol, sodium hydroxymethylglycinate, benzyl alcohol: these are solvents and fragrances and are more likely to trigger allergies
- Sulfates: often found in shampoos because they have a strong cleansing effect. For the skin, it may be too aggressive.
- Propylene glycol and propanediol. Is in make-up, cosmetics and amazingly also in muffins and cake.
- Toluene: diluent often found in nail polish and nail polish remover.
- Fluoride: in toothpaste
- Isopropyl myristate: is often found in body lotions and is quite safe for the skin. People with perioral dermatitis should watch out for it, because this substance is too aggressive for them.
- Oxybenzone: A substance that causes allergies on the skin. Is often found in sunscreen.
- Petrolatum (vaseline) PEGS and paraffin: seal the skin by putting a layer on it. Can help improve the skin barrier and lock in moisture, but in people with perioral dermatitis, it can close pores too much.
- Perfume
- Alcohol
- Oil-based foundation.
- Beeswax
- Colophony (resin) in chewing gum
Of food, chewing gum is the only product that can cause perioral dermatitis.
This condition is most common in women between the ages of 16 and 45. But children between 7 months and 13 years of both sexes are not spared either. In men, it is rare.
Perioral dermatitis can be effectively and safely treated by a skin specialist in the majority of patients.
The first step is to identify the cause. In the event that corticosteroids or other cosmetic products are the culprit, sometimes simply discontinuing their use is enough.
If that does not help, medication can be prescribed or local or oral antibiotics can be used. There is no single standard therapy. The situation and age of the patients is a leading factor. Oral antibiotics such as doxycycline, minocycline or tetracycline are often used, but they are less suitable for patients under 8 years of age. Lubricating with metronidazole or clindamycin or erythromycin is a good alternative in that case. Sometimes a combination of oral and the topical therapy is used.
Tips when you have perioral dermatitis
Below are tips from Dr. Francis Wu
Tip #1 - what ingredients can I safely use?
- Mineral-based sunscreen (zinc oxide and titanium dioxide).
- Mineral foundation.
- Safflower oil with linoleic acid: It improves the barrier function of the skin.
- Use skin care products that are not greasy, but have a restorative and calming capacity.
- Products such as niacinamide and vitamin C.
Tip #2 - how do I distinguish clown eczema from acne and rosacea?
One of the related skin diseases is rosacea. Both rosacea and perioral dermatitis are characterized by erythematous papules, red raised bumps on the face. However, rosacea is more common on the cheeks, nose, forehead and chin. The regions around the eyes and mouth are often free of papules in rosacea, while those are the hot spots in perioral dermatitis. There are no blackheads (comedones) in both rosacea and perioral dermatitis. What we do see with rosacea are telangiectasias (small dilated blood vessels). Despite being clinically similar, they differ in cause and prognosis.
Perioral dermatitis is confused not only with rosacea, but also with acne. Redness, papules and pustules are also symptoms that occur with acne. This sometimes makes diagnosis difficult. The preferred location and origin/belonging play an important role here. In addition, comedones are present in acne, which is not the case in perioral dermatitis. More on: recognize the different forms of acne.
What other conditions can resemble perioral dermatitis?
Also called differential diagnosis (DD). Conditions such as: contact eczema, lip licking dermatitis, atopic eczema, lupus miliaris, malabsorption syndrome (zinc deficiency) and demodex folliculitis.
Tip 3 - what are the treatment steps at home?
- Avoid using (strong-acting) corticosteroid creams on the face.
If you have atopic eczema and need treatment. Then a calcineurin inhibitor (such as protopic or elidel) ointment is an option. Elidel cream can be used from 2 years old, Protopic 0.03% and 0.1% ointment for teenagers and adults respectively. These are available only by doctor’s prescription. Try it on a small area of skin first, in some it may cause burning. The burning sensation diminishes after a few minutes to even an hour and after several days of consecutive smearing it disappears.
For people with psoriasis, Calcipotriol (Silkis) ointment, contains vitamin D is an option. New on the way is Tapinarof 1% cream, a hormone-free cream suitable for mild to severe psoriasis. Based on lubricating once a day, the severity of the psoriasis decreased for 12 weeks.
- Do not use greasy closing cosmetics such as foundation, Vaseline, silicone.
- Cleanse your skin daily with lukewarm water and use nourishing skin care products.
Tip 4 - The best care products
Natural Moisturizer Cream has a 3-fold action. The combination of glycerin, ceramide, squalane and an Iconic natural balm ensure that the moisture remains in your skin. This unique composition keeps the skin hydrated without feeling heavy on the skin.
Sensitive cream is suitable for people with sensitive skin or a tendency to develop skin irritation. The Sensitive cream is suitable for this group of people to keep the fragile skin optimal.
Calming cream is there for when skin irritation, flakes, red areas are present. It is one phase further, it calms irritated skin, itching, redness.
Tip 5 - Vitamin B3 (Niacinamide)
Niacinamide makes the skin less sensitive and removes redness. A recent clinical study investigated how facial redness changed in 59 female participants with cutaneous erythema (redness of the skin). The study included two test treatment groups with volunteers applying two different niacinamide substances twice a day for 28 days. The researchers found a statistically significant reduction in facial redness for both groups after 15 days compared to baseline. They also reported that after 29, treatment was more effective in subjects with severe erythema than in subjects with moderate facial redness.
The best products for perioral dermatitis
Below are some products that can help you.
- All products have the ideal pH 5 acidity – for good skin resistance and skin barrier.
- Vegan, Zero Plastic inside
- Iconic Elements skincare has been named the Best Holistic skincare line 2022 by EU Business News.
No hard evidence on this, but indirect indications.
People with diagnosed inflammatory bowel diseases such as ulcerative colitis and Crohn's disease are sometimes also diagnosed with perioral dermatitis. The question is whether it is due to treatment with immunosuppressive medication such as prednisone or due to intestinal inflammation itself.
There are no controlled studies - linking a relationship between carbohydrate or gluten intake to perioral dermatitis.
Did demonstrate a strong link between diet and rosacea. Rosacea is known to be aggravated by alcohol, hot or spicy foods, and chocolate.
Clinical experience of dr. Francis Wu there may be a connection between perioral dermatitis and diet
If you actively ask whether there are also abdominal complaints in addition to perioral dermatitis, the answer is sometimes YES.
When these patients switch to a gluten-free diet, their skin condition improves. Even patients without clinically diagnosed gluten sensitivity may benefit from a carbohydrate-free or low glycemic index*, gluten-free and high-protein diet.
*Foods with a high Glycemic Index (GI) cause a rapid rise in blood sugar.
The starting point is of course to stop using cosmetic products that cause perioral dermatitis. Perioral dermatitis often responds readily to therapy, but can be chronic and recurrent. The prognosis of perioral dermatitis is good. Avoiding all externalities often leads to improvement. The scar that remains after the treatment heals on its own, although it can sometimes take a long time.
