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. It rarely occurs in men . Perioral dermatitis can persist if left untreated. In most cases they eventually resolve, but this can take weeks to months. With proper treatment, symptoms and rashes are likely to clear up much faster.

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.

Acne vulgaris manifests itself as inflamed papules, pustules, cysts and comedones on the face, chest and back. Mechanical causes such as friction from a helmet strap can lead to flare-ups and the involvement may resemble perioral dermatitis. Acne in adult women is characterized by inflamed papules on the chin and jawline and resembles perioral dermatitis.

Allergic contact dermatitis presents with flaking macules, patches and plaques with possible coarsening of the skin.

Demodex folliculitis causes scattered erythematous papules and pustules on the face, associated with Demodex mites, which are also involved in rosacea.

Irritant cheilitis, such as lip licker cheilitis, leads to redness and flaking of the lips and usually affects the lip margin.

Rosacea is a condition that manifests mainly in the central part of the face, including the nose, with inflamed papules and pustules. Telangiectatic erythema with flushing is often associated. Perioral dermatitis is often considered a variant of rosacea due to similar responses to treatments. A distinctive feature is the absence of comedones, which are characteristic of acne.

Sarcoidosis can cause reddish-brown papules on periorific areas of the face. These lesions are usually more extensive, may occur elsewhere on the skin, and are often associated with systemic symptoms.

Seborrheic dermatitis causes erythematous patches of greasy scales on various parts of the face and chest.

Syringomas and other benign lesions may cause lesions that resemble perioral dermatitis, with flesh-colored to erythematous facial papules. A biopsy can help with the diagnosis.

Tinea faciei, fungal infection of the face, results in erythematous scaly papules and annular plaques.