Perioral dermatitis

The main symptom of inflammation is redness, which can have different underlying causes and requires a different approach to care, and often treatment. In addition to the redness itself, its localization, accompanying symptoms and sensations can tell us a lot about the cause of inflammation. In any case, it is crucial you seek medical attention for any long-term and acute redness. We will dive into many dermatoses through our series of articles, so that you can ask yourself the right questions and seek medical attention if necessary. Today we will cover everything you need to know about perioral dermatitis.

WHAT IS PERIORAL DERMATITIS, AND WHY DOES IT OCCUR?

Perioral dermatitis is a chronic inflammatory dermatosis of the facial skin. It occurs in the area around the mouth, and sometimes it spreads to the nose and eyes. Perioral dermatitis is recognizable by red bumps that look like pimples and usually appear on the nasolabial lines and cause burning, itching and tightening of the skin. Most patients are young and middle-aged women, but perioral dermatitis can also occur in children and men.

Perioral dermatitis symptoms

The etiopathogenesis of perioral dermatitis is unclear, with diverse potential endogenous and exogenous factors. There is a significant link between the local application of corticosteroids and the appearance of perioral dermatitis. These are used in the treatment of seborrheic dermatitis, rosacea or acne. Namely, people suffering from perioral dermatitis initially have a damaged skin barrier, and local corticosteroids lead to further deterioration. There is increased transepidermal water loss and slower recovery of the skin barrier. The amount of epidermal lipids, including ceramides, is reduced, and the same applies to collagen and elastin fibres. It is believed that the use of topical corticosteroids damages the wall of the hair follicle, which precedes the development of edema in the follicle cells.

Development of perioral dermatitis can also be preceded by the excessive use of moisturizing creams, especially those based on paraffin and vaseline, leading to occlusion and irritation of the follicles. As a result, the epidermal barrier becomes dysfunctional, and there is edema in the stratum corneum. On top of that, transepidermal water loss increases, which manifests as a feeling of tightness and dryness.

Perioral dermatitis can also be a result of the use of decorative cosmetics, sun protection creams, fluoridated toothpaste, and even bacterial or fungal infections. Hormonal changes are also one possible cause, afflicted by fluctuations during the premenstrual period, pregnancy or the use of oral contraceptives. Symptoms often worsen after exposure to UV rays, heat or wind.

HOW TO TREAT PERIORAL DERMATITIS?

The treatment of perioral dermatitis requires an individual approach depending on the severity of the disease. The most important step is to identify and eliminate possible causes. Treatment usually begins with 'zero therapy', which implies a complete cessation of all topical medications and cosmetics usage, especially corticosteroids and cosmetics based on paraffin and petroleum jelly. "Zero therapy" may be sufficient in treating mild forms of perioral dermatitis, but special attention should be paid to patients whose perioral dermatitis is caused by corticosteroids. After stopping their use, the initial worsening of the disease occurs, known as the "rebound phenomenon".

If no improvement occurs after several weeks of 'zero therapy',  local therapy is introduced. Many local preparations have proven to be successful in treating perioral dermatitis. The most common ones used are metronidazole, erythromycin, azelaic acid and adapalene.

In more severe forms of the disease, when the desired effect is not achieved after several weeks of local therapy, you should resort to systemic therapy 6 to 8 weeks, and in exceptional cases even longer. 

In the systemic treatment of perioral dermatitis, oral tetracyclines (minocycline or doxycycline) are most often used. This excludes children under 8 years of age, pregnant women and persons sensitive to tetracyclines. In such cases, a doctor may prescribe oral macrolides (erythromycin or less commonly clarithromycin). In rare cases when perioral dermatitis proves refractory to any other therapeutic option, isotretinoin is used.

In the treatment of perioral dermatitis, identifying and removing possible causes is crucial. In most cases, patients achieve a complete regression of symptoms. Therefore, it is of great importance to react in time and not delay the visit to the dermatologist, who will give you the correct diagnosis and prescribe adequate therapy. It is also very important to reduce the use of cosmetics to a minimum in order to prevent severe skin inflammation.

WHAT SHOULD YOU USE?

If your skin is prone to inflammation, it is recommended to use Skintegras Spectra, a hypoallergenic emollient-type serum emulsion intended especially for skin with a damaged hydrolipidic barrier, and reduced skin function. Any skin prone to dermatitis is a candidate for Spectra, as it soothes and nourishes the skin with its potent anti-inflammatory ingredients, resulting in reduced skin sensitivity and inflammation.

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