▶Periorificial dermatitis is an acneiform disorder of facial skin commonly seen in older teenagers and young adult women but also in younger children (Figure 9.1).
▶The “adult” or “classic” presentation is best characterized as an acne variant in a spectrum between acne vulgaris and acne rosacea, displaying a combination of acneiform papules/pustules along with varying degrees of erythema.
▶A granulomatous juvenile variant of “classic” periorificial dermatitis exists. It is sometimes referred to as granulomatous periorificial dermatitis.
▶The cause is unknown, but it has been associated with chronic application of topical corticosteroids (or use of steroids in other forms, including inhaled), as well as bubble gum, oils, greases, and toothpastes.
▶Boys and girls are equally affected; it is more common in black children.
▶Skin-colored to red, monomorphous papules and papulopustules on a red background, distributed around the mouth, with a narrow zone of sparing around the vermillion border (see Figure 9.1).
▶Scaling is commonly present.
▶Other periorificial areas are commonly affected, including the perinasal and periorbital regions.
▶The granulomatous variant presents in a similar fashion but with prominence of translucent, pink papules (Figure 9.2) and often a history of prior corticosteroid application.
Look-alikes
Disorder | Differentiating Features |
•Less papular. •Other areas of body usually affected. •Pruritus usually present. | |
Acne vulgaris | •Distribution of early lesions more commonly in the T-zone (ie, forehead, nose, and chin). •Comedones present. •Onset rarely occurs between 1 and 7 years of age. |
•Less papular. •History of exposure to antigen may be present. •Pruritus usually present and significant. | |
Irritant contact dermatitis (eg, caused by lip licking or pacifier) | •Less papular. •History of lip licking or pacifier use present. •Involved areas often have sharp geometric borders. Vermilion border is typically involved. |
•Small, skin-colored to tan, flat-topped papules and plaques. •Erythema absent. •May be present elsewhere. •Koebnerization (ie, distribution of lesions in a linear fashion following skin trauma or scratching) may be evident. | |
•When limited to face, may be difficult to distinguish from periorificial dermatitis. •Papules often red-brown in color. •Often in other locations (eg, neck, upper trunk, extremities). | |
•Usually occurs in children 3 years or younger. •Papules may be erythematous, but often yellow-brown, and may simulate flat warts. |
▶The diagnosis is made clinically based on lesion morphology and characteristic distribution.
▶Skin biopsy may be useful in questionable cases but is rarely necessary.
▶Mild cases: topical antibiotics, most commonly metronidazole or erythromycin, applied once to twice daily; topical sulfacetamide with or without sulfur may also be useful, as may topical calcineurin inhibitors (eg, pimecrolimus cream, tacrolimus ointment).
▶Severe cases: oral antibiotic therapy (eg, with erythromycin; in patients >8 years, doxycycline or minocycline).
▶Topical corticosteroids lead to initial improvement, but rapid flaring is seen on their discontinuation. If the patient has been treated with these agents, gradually taper the potency of the agent over 2 to 4 weeks or consider use of a topical calcineurin inhibitor while concurrently initiating appropriate therapy as outlined previously.
▶The condition improves slowly (often requires 4–12 weeks) but steadily with appropriate therapy.
▶Treatments should be used until clearing has occurred, with gradual tapering to prevent rebound.
▶Postinflammatory hyperpigmentation or hypopigmentation may be seen and generally resolves over several months.
▶Consider referral if the diagnosis is in question or the patient has not responded to appropriate therapy.
▶Society for Pediatric Dermatology: Patient handout on perioral dermatitis
https://pedsderm.net/for-patients-families/patient-handouts/#PerorialDermatitis
▶WebMD: Information for families is contained in Skin Problems and Treatments.
www.webmd.com/skin-problems-and-treatments/perioral-dermatitis