This condition, also known as periorificial dermatitis, is a rosacea-like eruption seen primarily in young women and children (see Chapter 3: Acne).
It is usually found circling the mouth (Fig. 12.17), but it may be noted around the eyes and nose (which explains the more inclusive term, “periorificial”) (Fig. 12.18).
As with rosacea, the etiology is unknown but the application of potent topical steroids and the use of fluoridated toothpaste have been implicated.
Clinical features that may help distinguish perioral dermatitis from rosacea include the following:
Rosacea induced by topical steroids is often clinically indistinguishable from ordinary rosacea, but a history of long-term, indiscriminate misuse of a potent topical steroid on the face helps confirm the diagnosis. It is sometimes referred to as “steroid use/abuse/misuse/dermatitis” (Fig. 12.19).
The topical steroid may have been prescribed for another family member or for another skin condition and then overused by the unsuspecting person, who continues to apply it.
The condition typically worsens when the topical steroids are discontinued (an occurrence known as “rebound rosacea”).
In an unfortunate cycle, the steroid is sometimes reapplied to diminish the erythema, which only worsens the condition.
This condition is treated by stopping the offending topical steroid and by taking a tetracycline derivative for a few weeks or more to get over the “hump” of the rebound.
Helpful Hint Rhinophyma is an uncommon yet unsightly manifestation of rosacea and usually occurs in men over 40. It is rarely seen in women.
It consists of knobby nasal papules that tend to become larger and swollen over time (Fig. 12.20).
The usual treatments for rosacea are not effective for rhinophyma.
Recontouring procedures with a scalpel or a carbon dioxide laser have been used successfully to remove (“sculpt”) the excess nose tissue, resulting in a more normal shape and appearance. This may also be accomplished by electrocautery and dermabrasion.
Outline