Perioral dermatitis L71.0

Authors: Prof. Dr. med. Peter Altmeyer, Pia Nagel

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Last updated on: 13.01.2021

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Synonym(s)

Dermatitis rosacea-like; Light sensitive seborrhoids; perioral dermatitis; perioral rosacea; periorificial dermatitis; rosacea-like dermatitis; rosacea periorale; rosacea perioralis; steroid rosacea (e); Stewardess disease

History
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Frumess and Lewis 1957; Mihan and Ayres 1964

Definition
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Dermatitis limited to the perioral facial skin, usually chronically persistent or chronically recurrent, with extensive erythema, red disseminated follicular papules, pustules, plaques, accompanied by itching/burning or painful dermatitis, which occurs primarily in "cosmetic-conscious" young women.

Occurrence/Epidemiology
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This now common clinical picture, which is related to rosacea, has only emerged in the last 3 decades and is probably related to the care habits that have been common since then.

Etiopathogenesis
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Unknown, as triggering factors a seborrhoeic constitution, gastrointestinal disorders, sunlight, ovulation inhibitors, a degenerative-toxic contact eczema or after-effects of a longer local corticoid therapy are discussed. Candida species and various bacteria, such as fusiform spirals or rod bacteria, were also attributed a causal role. However, in most cases there is a pronounced misuse of skin care cosmetics (which are frequently incorrectly and too warmly stored!) and/or of creams / ointments containing glucocorticoids which are applied uncontrolled in cases of banal inflammations of the facial skin.

Manifestation
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Occurs mainly in the 20 to 45 year old age group, mainly in women. Only rarely are men or infants affected. The latter usually experience the same "intensive" local therapy as their worried mothers.

Localization
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Chin, nasolabial folds, lateral mouth parts, forehead, periorbital, possibly extending to the entire face, the lateral neck parts and the retroauricular area. Typical is the free zone perioral (here the vellus hairs are missing, which are affected by perioral dermatitis!)

Notice! The disease can also occur (less frequently) isolated in the area of the eyelids and periorbital as "periorbital dermatitis" (see below eczema, eyelid eczema).

Clinical features
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In the reddish, slightly swollen and scaly skin of the perioral region, there are disseminated or grouped, 0.2-0.4 cm large, red, scaly follicular papules, papulovesicles and papulopustules. The skin lesions are blurred to the lateral parts of the face with leaking follicular papules and scaly erythema. Over the entire inflammatory area there is usually a distinct itching or sometimes an unbearable feeling of tension which can only be alleviated by applying creams (Circulus vitiosus especially if these skin care creams contain glucocorticoids).

A characteristic feature is the absence of a skin zone directly bordering on the lip red which results in a typical multizone picture with free lip red, free perioral border and a dermatitis ring of varying width.

The clinical picture is variable. There are often nodules in the nasolabial folds as well as in the corners of the eye.

Special form: Lupoid perioral dermatitis.

Therapy
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"Any successful therapy approach is based on weaning patients off their previous (beloved) care habits". This includes:

Removal of all cosmetics and ointments and especially all glucocorticoid externa!

Cleaning of the face without the use of other chemicals.

The careful use of microfibre cloths, e.g. Claroderm, has proven to be effective here; this can be used to remove ointment residues.

If additional cleansing of the face is necessary, use a syndet (e.g. Dermowas or Sebamed liquid) sparingly.

Dab the face briefly with a clean towel (do not rub!).

Avoid perfumes in cosmetics, detergents, room sprays.

External therapy
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Since a "zero-therapy" is usually not feasible, mild antiphlogistically effective topical preparations should be used:

  • Leukichtan Gel (active ingredient: sodium bituminosulphate) applied in a very thin layer in the evening and a non-perfumed moisturizer or gel applied in the morning.
  • In stubborn cases, a zinc-containing Ichthyol® ointment can also be used.
  • Alternative: Skinoren gel. Caution! First check the compatibility!
  • In case of a strong feeling of tension of the face, black tea compresses can be applied (2-3 bags of black tea should be steeped for about 10-15 min.; after cooling down, apply to the face with a linen cloth for 10-15 min.); alternatively: compresses with synthetic tanning agents (e.g. Tannosynt, Tannolact).
  • Therapy success can also be achieved by strictly "drying out" the skin: After cleansing the facial skin in the morning (see above), apply a solution containing erythromycin (e.g. R086, Aknemycin solution, Zineryt). Alternatively: Instead of erythromycin solutions, a 0.5-2% metronidazole gel (e.g. Metrogel) can be applied.
  • Covering of inflamed facial skin (e.g. Unifiance cream make-up, Lutsine make-up stick).
  • In case of long-term steroid abuse, "tapering" of the steroid externals with temporary use of low-concentration steroids(0.1-0.5% hydrocortisone cream as a formulation or as a ready-to-use drug, e.g. Hydrogalen) may be necessary to alleviate the withdrawal symptoms (interpreted by patients as treatment failure).

Internal therapy
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In severe cases doxycycline (e.g. doxycycline stada) 2 times/day 100 mg p.o. or minocycline (e.g. clinomycin) 2 times/day 50 mg p.o. In addition, sodium bituminosulfonates (e.g. Ichthraletten 3 times/day 2 Drg. 1. to 2. week, afterwards 3 times/day 1 Drg. p.o.).

Literature
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  1. Fritsch P et al (1989) Perioral dermatitis. Dermatologist 40: 475-479
  2. Frumess GM, Lewis HM (1957) Light sensitive seborrhoea. Arch Dermatol 75: 245-248
  3. Hafeez ZH (2003) Perioral dermatitis: an update. Int J Dermatol 42: 514-517
  4. Kalkoff KW et al. (1977) On the pathogenesis of perioral dermatitis. Dermatologist 28: 74
  5. Nolting S et al (1977) Origin and significance of perioral dermatitis. Münch Med weekly 110: 49
  6. Takiwaki H et al (2003) Differences between intrafollicular microorganism profiles in perioral and seborrhoeic dermatitis. Clin Exp Dermatol 28: 531-534
  7. Tempark T et al (2014) Perioral dermatitis: a review of the condition with special attention to treatment options. At J Clin Dermatol 15:101-113
  8. Wagner G et al (2014) Childhood granulomatous periorificial dermatitis. Dermatologist 65:903-907

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

Authors

Last updated on: 13.01.2021