Dermatology Patient Education

 

Randy Jacobs, M.D.

 

POD: PERIORAL DERMATITIS

Definition

Perioral dermatitis has been defined as a persistent erythematous (reddish color) eruption of the skin composed of tiny papules and little papulopustules, distributed primarily around the mouth.  Perioral dermatitis is a fairly recent dermatologic diagnosis. The condition was not widely recognized until the mid-fifties. Perioral dermatitis was given its present name in 1964, and the name describes the distribution of the rash.

 

What Causes POD?

The exact cause of perioral dermatitis is unknown. Attempts to incriminate certain microbial agents have been unsuccessful. Some have claimed that sensitivity to the sun is the main cause, but the sun’s role is now doubted due to lack of substantiation in many cases examined. Hormonal factors have been suspected because perioral dermatitis usually affects young women of child-bearing age and has been associated with the use of contraceptive pills. The hormonal etiologic evidence is interesting, however, hormones do not fully explain perioral dermatitis because many patients have never used contraceptive pills, and others did not improve after discontinuing them. Other perpetuating factors for perioral dermatitis that have been postulated include: Fluorinated toothpaste, cosmetic usage, emotional stress, and "fiddling" with the perioral region. Some observers have no doubt that the condition results in some way from prolonged therapy with powerful (usually fluorinated) topical corticosteroids applied for any reason to the perioral region. However, other researchers remain unconvinced. Dr. Jacobs feels that potent topical steroids may lead to POD.

 

What Does POD Look Like?

Perioral dermatitis is predominantly a disease of young women. The condition consists of a circumoral eruption of many minute papules, pustules, and various tiny papulopustules on an erythematous and sometimes scaly base. The lesions spread irregularly in clusters, or as plaques of erythema, edema, and micropustules until they completely surround the mouth. The extent of involvement varies from a few inconspicuous lesions to a disfiguring eruption involving most of the area bordered by the nasolabial fold and sides of the chin. In most cases, the perioral area alone is involved. It is characteristic that there is a narrow zone of normal skin sparing the area around the vermillion border of the lips. At times, perioral dermatitis may involve the forehead, eye areas, and the entire face.

           

How Does POD Progress?

The course of perioral dermatitis is one of fluctuations with recurrent acute flares of intense erythema and crops of papules. The primary lesion is a small pin-head sized papule or papulopustule that is either red or flesh-colored. These will dry up leaving a varying degree of scaling of the area. Mild to moderate itching and burning may be present. The affected area is often intolerant of sunlight and almost always to wind, heat, chlorinated pool water, and even hot water. Soaps and cosmetics may cause irritation, and even simple topical applications are badly tolerated. The total duration of the dermatitis can vary from months to years.

 

How Is POD Diagnosed?

The distinctive appearance of well established perioral dermatitis usually allows for no confusion with any other facial dermatosis. Differential diagnosis of perioral dermatitis includes: Seborrheic dermatitis, rosacea, contact dermatitis, acne vulgaris, and acne agminata.

           

How Is POD Treated?

Perioral dermatitis has proved to be one of the most difficult complexion skin conditions to treat. Perioral dermatitis is usually not responsive to topical medical treatments. The essential first step is: discontinuation of all strong topical steroid medications used on the face. Oral tetracycline 250 mg 2 to 4 times daily for 2 to 3 months has been effective in several studies. The antibiotic, Dynacin is also effective. Topical antibiotics may be of benefit when combined with oral antibiotics. Mild topical steroids may actually help POD. To cleanse your face, Dr. Jacobs suggests Gentle face and Body Cleanser available OTC. Use fragrance free True Moisture® Face Lotion if you desire a moisturizer. Use Gentle Shampoo and fragrance free conditioner. Be sure to avoid all allergic items including anything with fragrances. Pay careful attention to see if anything you are putting on your face is causing the rash. Often, POD comes when someone uses their hands to apply potent topical steroids to another part of their body, and then touches their face with their hands. Remember, with POD, don’t ever touch your face with your hands. Always use a tissue to touch your face. Once controlled, POD is usually maintained in nearly all patients. Some may need additional work. Patience is important if POD is to be controlled.