Perioral dermatitis

There are hundreds of topical steroid preparations that are available for the treatment of skin diseases. In addition to their aforementioned antiinflammatory effects, topical steroids also exert their effects by vasoconstriction of the capillaries in the superficial dermis and by reduction of cellular mitosis and cell proliferation especially in the basal cell layer of the skin. In addition to the aforementioned systemic side effects, topical steroids can have adverse local effects. Chronic treatment with topical corticosteroids may increase the risk of bacterial and fungal infections. A combination steroid and antibacterial agent can be used to combat this problem. Additional local side effects that can be caused by extended use of topical steroids are epidermal atrophy, acne, glaucoma and cataracts (thus the weakest concentrations should be used in and around the eyes), pigmentation problems, hypertrichosis, allergic contact dermatitis, perioral dermatitis, and granuloma gluteale infantum (251). 

Perioral dermatitis is characterized by erythema, scaling and small papules and pustules symmetrically distributed around the mouth, sometimes extending to the nasolabial folds and the cheeks. This condition typically occurs in females 20-40 years of age. Topical corticosteroids can exacerbate the disease and should be avoided. 

Hypersensitivity to any component monotherapy in primary bacterial infections such as impetigo, paronychia, erysipelas, cellulitis, angular cheilitis, erythrasma (clobetasol), treatment of rosacea, perioral dermatitis, or acne use on the face, groin, or axilla (very high or high potency agents) ophthalmic use. 

Hypertrichosis, hypopigmentation, maceration of skin, miliaria, perioral dermatitis, skin atrophy, striae... 

The local adverse effects of inhaled glucocorticoids have been studied in a prospective, cross-sectional, cohort study in 639 asthmatic children using beclomethasone (721 micrograms/day) or budesonide (835 micrograms/ day) for at least one month (28). The local adverse effects included cough (40%), thirst (22%), hoarseness (14%), dysphonia (11%), oral candidiasis (11%), perioral dermatitis (2.9%), and tongue hypertrophy (0.1%). A spacer doubled the incidence of coughing. 

Two cases of perioral dermatitis have been associated with the use of inhaled glucocorticoids (98). 

A 38-year-old woman who had used inhaled beclo-methasone daily (dosage not stated) during the winter for the past 5 years for mild asthma, developed a perioral rash with numerous small pustules and papules. She stopped using beclomethasone and was treated with oral erythromycin and topical tretinoin. Her rash resolved within 4 weeks. One year later, she restarted beclomethasone and her rash reappeared after 2 weeks. There was no recurrence of her perioral dermatitis during subsequent treatment with monthly intramuscular injections of betamethasone. 

Shiri J, Amichai B. Perioral dermatitis induced by inhaled corticosteroids. J Dermatol Treat 1998 9 259-60. 

Effects on the pilosebaceous unit Perioral dermatitis (SEDA-5, 151)... 

Steroid rosacea or rosacea-like dermatitis cannot be differentiated from perioral dermatitis and can be identical Steroid acne... 

Evidence from at least one randomized controlled trial (level I) show that 10% urea is effective for the treatment of psorisasis, ichthyosis, and dry feet, and 4 to 10% for the treatment of dry atopic skin and senescent skin. Evidence from another well-designed clinical study (level II) supports the treatment of hand dermatitis with urea. Evidence at level I also exist showing barrier improving effects of urea in both normal and in dry skin disorders (atopic skin, ichthyosis). Furthermore, strong evidence exists (level I) for reduced susceptibility to SLS, but not to other external agents. No evidence has been found for successful treatment of seborrhoic dermatitis, perioral dermatitis, and keratosis pilaris with urea. 

There have been reports of perioral dermatitis, urticaria, and stomatitis due to menthol (1,6). 

Lindner K+, Dermatol Monatsschr (German) 176, 483 Fixed eruption Hypersensitivity Lichenoid eruption Perioral dermatitis... 

Weakness, lethargy, cachexia, amenorrhea, vomiting, restricted food intake, inappropriate exercise, delayed sexual development, edema, delayed gastric emptying, constipation, bradycardia, hypotension, osteoporosis, dry cracking skin, lanugo, callus on dorsum of hand, perioral dermatitis, erosion of dental enamel... 

Perioral dermatitis—Rash around the mouth. In patients with... 

In healthy individuals taking oral antibiotics for acne, laboratory monitoring is not necessary. Orally administered antibiotics also may be indicated in other noninfectious conditions, including acne rosacea, perioral dermatitis, hidradenitis suppurativa, autoimmune blistering diseases, sarcoidosis, and pyoderma gangrenosum. 

Decubitus ulcers acne rosacea perioral dermatitis... 

TOXICITY AND MONITORING Chronic use of potent topical glucocorticoids (e.g., diflo-rasone diacetate 0.05%, betamethasone dipropionate 0.05%) can cause skin atrophy, striae, telang-iectasias, purpura, and acneiform eruptions. Because perioral dermatitis and rosacea can develop after the use of fluorinated compounds on the face, they should not be used in this site. 

Farkas, J. 1981. Perioral dermatitis from marjoram, bay leaf and cinnamon. Contact Dermat. 7(2) 121. 

Diagnosis is usually easy, but acne may be confused with folliculitis, rosacea, or perioral dermatitis. However, in these skin conditions, there are no comedones. Comedonal acne has to be differentiated from milia and sebaceous hyperplasia. Inflammatory acne could mimic rosacea or perioral dermatitis. Rosacea is... 

Acne, folliculitis due to Gram-negative bacteria, fungi and yeasts, perioral dermatitis, and steatocystoma multiplex should be considered in differential diagnosis. 

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