What happens to the skin
With perioral dermatitis, the hair follicles and surrounding skin become inflamed, its protective barrier is disrupted and moisture loss increases. The skin becomes sensitive and reacts to products that it previously tolerated well. Many experts consider the disease as a type of rosacea. There is a granulomatous form, which is more common in children and appears as yellowish-brown nodules around the mouth, nose and eyes. If the rash is located predominantly near the eyes, it is referred to as periocular dermatitis.
- Classic perioral form
- Perinasal - at the wings of the nose
- Periocular - around the eyes
- Granulomatous form in children
- Facial dermatitis caused by hormonal creams
Causes and risk factors
The most significant provoking factor is the use of creams with glucocorticosteroids on the face. They suppress inflammation for a while, but after withdrawal the rash returns stronger and a vicious circle is formed. Hormone inhalers and nasal sprays have a similar effect if the drug comes into contact with the skin. The disease is supported by thick creams and foundations, application of several layers of care, and frequent changes of cosmetics. The role of fluoride toothpastes, hormonal changes, skin microorganisms and the sun is discussed.
- Hormonal ointments and creams on the face
- Inhaled and nasal glucocorticosteroids
- Fatty creams and decorative cosmetics
- Excessive care and frequent washing with soap
- Toothpastes with fluoride and sodium lauryl sulfate
- Ultraviolet, wind, heat
Symptoms
The rash usually appears gradually. These are small, 1–2 mm in size, pink or red nodules, sometimes with a purulent head, against a background of redness and peeling. The rash is located around the mouth, in the nasolabial folds and on the chin, while a strip of unchanged skin remains at the very border of the lips. Patients note a burning sensation, tightness and mild itching, especially after washing or applying cosmetics. Unlike acne, perioral dermatitis does not have blackheads.
- Small red papules and pustules
- Redness and peeling
- Burning and tightness of the skin
- A clean strip at the edge of the lips
- No blackheads
- Strengthening after cosmetics
Diagnostics
The diagnosis is made upon examination based on the characteristic pattern and history of cream use. The doctor distinguishes perioral dermatitis from acne, rosacea, seborrheic and contact dermatitis, impetigo. If there is a suspicion of a bacterial infection, a skin culture is performed. If the course is persistent, scrapings are sometimes taken to detect demodex mites and fungi. A biopsy is rarely needed, mainly in the atypical granulomatous form, when the picture resembles other diseases.
- Examination by a dermatologist
- Analysis of the products and medications used
- Scraping for demodex and fungi
- Bacterial culture for pustules
- Biopsy - only in unclear cases
Treatment and care
The first rule is to stop applying hormonal creams to your face that have not been used as directed. After their discontinuation in the first weeks, a temporary increase in the rash is possible; this is an expected reaction. Many patients benefit from “zero” therapy: giving up cosmetics, scrubs and thick creams, washing with warm water. The doctor may prescribe local anti-inflammatory and antimicrobial agents, and in case of a widespread process, a course of systemic medications. The result is assessed after 4–8 weeks; There is no need to interrupt treatment at the first improvement.
- Do not apply hormonal creams to your face without a doctor's prescription
- Temporarily avoid foundations and thick creams
- Wash with warm water without soap
- Use light products for sensitive skin
- Protect skin from the sun
- Do not squeeze the rash