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perioral dermatitis; periorificial dermatitis
Etiology:
1) associated with use of potent topical steroids
- prolonged glucocorticoid therapy for atopic dermatitis
- inappropriate use of topical glucocorticoids to treat acne
2) zinc deficiency
3) idiopathic (unknown)
Epidemiology:
1) age 20-30 & may occur in children
2) predominantly disorder of young women
Clinical manifestations:
1) papulopustules on an erythematous background (acneiform)
- small (< 2 mm) papules & pustules around the mouth or eyelids
2) papules often become confluent forming inflammatory plaques
3) lesions of weeks to months duration
4) perioral distribution of lesions
- generally spares skin around lips
5) periorbital lesions less common
6) resembles acne
7) no comedones
* images [4]
Laboratory:
- culture for Staphylococcus aureus
Differential diagnosis:
1) allergic contact dermatitis
2) atopic dermatitis
3) seborrheic dermatitis
4) rosacea
5) acne vulgaris
6) steroid acne
Management:
1) topical antibiotics
- metronidazole 0.75% gel or cream BID
- erythromycin 2.0% gel BID
2) systemic antibiotics
a) minocycline or doxycycline
- 100 mg PO BID until clear, then
- 100 mg QD for 1 month, then
- 50 mg QD for an additional month
b) tetracycline
- 500 mg BID until clear
- 500 mg QD for 1 month
- 250 mg QD for an additional month
3) avoid corticosteroids - may be markedly aggravated by fluorinated corticosteroids
General
sebaceous gland disease
acneiform eruption
References
- Color Atlas & Synopsis of Clinical Dermatology, Common
& Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY,
1997, pg 16-17
- Medical Knowledge Self Assessment Program (MKSAP) 11, 17,
American ollege of Physicians, Philadelphia 1998, 2015
- Kammler HJ, James WD
Medscape: Perioral Dermatitis
http://emedicine.medscape.com/article/1071128-overview
- DermNet NZ. Perioral dermatitis (images)
http://dermnetnz.org/acne/perioral-dermatitis.html
- Kammler HJ, James WD
Medscape: Perioral Dermatitis
http://emedicine.medscape.com/article/1071128-overview