Perioral Dermatitis

Perioral Dermatitis

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Perioral dermatitis (POD) is a chronic papulopustular facial dermatitis. It mostly occurs in women and children. [1] The clinical and histologic features of the perioral dermatitis lesions resemble those of rosacea. Patients require systemic and/or topical treatment and an evaluation of the underlying factors.

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The etiology of perioral dermatitis (POD) is unknown; however, the long-term use of topical steroids for minor skin alterations of the face often precedes the manifestation of perioral dermatitis. Perioral dermatitis is limited to the skin.

An underlying cause of the perioral dermatitis (POD) cannot be detected in all patients. 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. Note the following:

Drugs: Many patients abuse topical steroid preparations. [2] No clear correlation exists between the risk of perioral dermatitis and strength of the steroid or the duration of the abuse. Perioral dermatitis has also been reported after the use of nasal steroids [3] and steroid inhalers.

Cosmetics: Fluorinated toothpaste [4, 5] ; 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. Physical sunscreens have been identified as a cause of perioral dermatitis in children. [6]

Physical factors: UV light, heat, and wind worsen perioral dermatitis.

Microbiologic factors: Fusiform spirilla bacteria, Candida species, and other fungi have been cultured from lesions. Research from 2015 suggests to differentiate perioral dermatitis caused by rod-shaped bacteria (possible fusobacteria) and corticosteroid-induced rosacea. [7]

Miscellaneous factors: Hormonal factors are suspected because of an observed premenstrual deterioration. Oral contraceptives may be a factor.

United States

The incidence of perioral dermatitis (POD)  is estimated to be 0.5-1% in industrialized countries, independent of geographic factors.


The incidence of perioral dermatitis seems to be lower in less developed countries, but no statistics are available.

In adults, perioral dermatitis predominantly affects young females, who account for an estimated 90% of the cases. The number of male patients is assumed to be increasing because of changes in their cosmetic habits.

In adults, the vast majority of patients are women aged 20-45 years. Perioral dermatitis also occurs commonly in children.

Perioral dermatitis (POD) is not a life-threatening disease. However, unexpectedly long period of treatment may be required to achieve a cosmetically satisfactory skin condition.

Reassurance and education about possible underlying factors and the time course of the disease are critical. These measures help the patient to cope with the character of the disease and help to minimize the risk of recurrences.

Patients have to be aware that initial deterioration may occur, especially if they previously used a topical steroid.

The use of all topical preparations, including cosmetics, should be avoided except the prescribed medication.

The patient should be advised that remission might not occur for many weeks, despite correct treatment.

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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 Hermal GmbH; Dr. Regenold GmbH; <br/>Serve(d) as a speaker or a member of a speakers bureau for: FORUM Institut für Management GmbH.

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.

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, 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, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD.

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.

Perioral Dermatitis

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