Perioral (periorificial) dermatitis
- Jason Reichenberg, MD
Jason Reichenberg, MD
- University of Texas Southwestern-Austin Program
Perioral dermatitis (POD), also known as periorificial dermatitis, is a skin disorder that typically presents with multiple small inflammatory papules around the mouth, nose, or eyes. Although the name "perioral dermatitis" suggests a primarily eczematous condition, POD most often resembles an acneiform or rosacea-like eruption with or without associated features of a mild eczematous dermatitis. The pathogenesis of POD is poorly understood; both intrinsic factors and extrinsic factors, such as irritants and topical corticosteroids, may contribute to this disorder. Topical anti-inflammatory agents and topical or systemic antibiotics constitute the major pharmacologic options for therapy.
The clinical features, diagnosis, and management of POD will be discussed here. The differential diagnosis of disorders that present with inflammation of facial skin is reviewed separately. (See "Approach to the patient with facial erythema".)
Perioral dermatitis (POD) was first described in 1957 under the moniker "light sensitive seborrheid" . Since then, an association with light exposure has largely been discounted [2,3]. In 1964, "perioral dermatitis" was introduced as the preferred term to refer to this disease . Some authors have advocated for utilization of the term "periorificial dermatitis," a name that reflects the various potential sites of POD [5,6]. (See 'Clinical manifestations' below.)
Perioral dermatitis (POD) occurs worldwide and in individuals of all racial and ethnic backgrounds. Although women between the ages of 16 and 45 constitute the vast majority of patients affected by POD, POD may also occur in older individuals, men, and children [7,8].
Childhood POD often occurs in young children. A retrospective study of 222 children with POD seen at an academic dermatology department found an average age of presentation of 6.6 years . POD may develop in infants as young as three months of age . Girls may be slightly more likely to develop POD than boys. In a retrospective study, 46 of 79 children and adolescents with POD (58 percent) were female .
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- ETIOLOGY AND PATHOGENESIS
- CLINICAL MANIFESTATIONS
- Granulomatous periorificial dermatitis
- Disease course
- DIFFERENTIAL DIAGNOSIS
- Approach to therapy
- Elimination of corticosteroids and irritants
- First-line topical pharmacologic agents
- - Topical calcineurin inhibitors
- - Topical erythromycin
- - Topical metronidazole
- First-line systemic agents
- - Oral tetracyclines
- - Oral macrolides
- Other therapies
- - Ivermectin
- - Additional interventions
- SUMMARY AND RECOMMENDATIONS