Practice Essentials

Perioral dermatitis (POD), also known as periorificial dermatitis, is a papulopustular facial dermatitis. It most commonly affects adolescent and young adult women, but can also occur in children, older adults, and men.^{[1, 2]} The clinical and histologic features of the perioral dermatitis lesions resemble those of rosacea. Treatment involves avoiding potential triggers as well as systemic and/or topical medications.

See the image below.

Perioral dermatitis. Courtesy of Professor Raimo Suhonen and DermNet New Zealand (https://www.dermnetnz.org/assets/Uploads/acne/s/pod6.jpg).

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Pathophysiology

The etiology of perioral dermatitis (POD) is unknown. Skin barrier dysfunction is commonly observed in those with POD.^[3] Topical or inhaled corticosteroids are often reported as potential triggers of perioral dermatitis. Other suggested triggers include fragrances, cosmeceutical products, and fluorinated toothpastes.

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Etiology of Perioral Dermatitis

The etiology of perioral dermatitis is unknown; however, long-term use of topical steroids for minor skin alterations of the face often precedes the manifestation of the disease.

Drugs

Some patients may be overusing topical steroid preparations on the face.^[4]No clear correlation exists between the risk of perioral dermatitis and strength of the steroid or the duration of the use. Perioral dermatitis has also been reported after the use of nasal steroids^[5]and steroid inhalers.

Cosmeticeuticals

Fluorinated toothpaste use has been associated with perioral dermatitis.^[6]

Skin care ointments and creams, especially those with a petrolatum or paraffin base, and the vehicle isopropyl myristate are suggested to be causative factors. In an Australian study, applying foundation in addition to moisturizer and night cream resulted in a 13-fold increased risk for perioral dermatitis. The combination of moisturizer and foundation was associated with a lesser but significantly increased risk for perioral dermatitis, whereas moisturizer alone was not associated with an increased risk.^[7]

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Epidemiology

There is limited data on the epidemiology of perioral dermatitis (POD). Most patients are women ages 20-45 years-old, but perioral dermatitis can also occur in children, older adults, and men

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Prognosis

Limited data is available regarding the long-term prognosis of perioral dermatitis. Some patients may achieve resolution of symptoms within a few months whereas others may have a more persistent disease course. Recurrences can occur after successful treatment.

Next: Pathophysiology

Patient Education

Education about triggers and risk factors is important to address potential underlying causes of the eruption. This is particularly important for topical steroids; although patients may notice temporary improvement with topical steroid use, these can contribute to persistent disease activity if not discontinued. During treatment, use of other cosmeceutical and skin care products should be limited. Anticipatory guidance and setting appropriate expectations (e.g. treatment can take at least 4-8 weeks to see improvement) is important to ensure adherence to treatment.

Clinical Presentation

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Media Gallery

Perioral dermatitis. Courtesy of Professor Raimo Suhonen and DermNet New Zealand (https://www.dermnetnz.org/assets/Uploads/acne/s/pod6.jpg).

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Author

John Samuel Barbieri, MD, MBA Assistant Professor, Department of Dermatology, Harvard Medical School; Associate Physician, Department of Dermatology, Brigham and Women's Hospital; Physician, Department of Dermatology, Dana-Farber Cancer Institute; Founder and Director, Advanced Acne Therapeutics Clinic, Dana-Farber Cancer Institute

John Samuel Barbieri, MD, MBA is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology, Women's Dermatologic Society, American Acne and Rosacea Society, Pediatric Dermatology Research Alliance

Disclosure: Received income in an amount equal to or greater than $250 from: Honeydew Care.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

William D James, MD Emeritus Professor, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, American Contact Dermatitis Society, Association of Military Dermatologists, Association of Professors of Dermatology, American Dermatological Association, Women's Dermatologic Society, Medical Dermatology Society, Dermatology Foundation, Society for Investigative Dermatology, Washington DC Dermatological Society, Atlantic Dermatologic Society, Philadelphia Dermatological Society, Pennsylvania Academy of Dermatology, College of Physicians of Philadelphia

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Additional Contributors

Hans J Kammler, MD, PhD Director and Professor, University Medical Center Bonn, Germany

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Almirall S.A.

Andrea Leigh Zaenglein, MD Professor of Dermatology and Pediatrics, Department of Dermatology, Hershey Medical Center, Pennsylvania State University College of Medicine

Andrea Leigh Zaenglein, MD is a member of the following medical societies: American Academy of Dermatology, Society for Pediatric Dermatology

Disclosure: Received consulting fee from Galderma for consulting; Received consulting fee from Valeant for consulting; Received consulting fee from Promius for consulting; Received consulting fee from Anacor for consulting; Received grant/research funds from Stiefel for investigator; Received grant/research funds from Astellas for investigator; Received grant/research funds from Ranbaxy for other; Received consulting fee from Ranbaxy for consulting.