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Definition

Perioral dermatitis is a common facial rash. It is characterized by tiny red papules (bumps) around the mouth. Perioral dermatitis most commonly affects young women. However, it may sporadically affect men. People can get this any time between their mid-teens and menopause, but it occurs most often to people in their 20’s.

Causes

A variety of causes have been proposed, including exposure to topical corticosteroids and/or fluoride in water and toothpaste, but etiology is unknown. Hormones may play a role. Cosmetic products and moisturizers in particular may worsen the rash. Some experts believe perioral dermatitis may be related to rosacea. Stress also plays a role, as does repeatedly touching the skin on the face. Face creams applied to the area bounded by the cheek folds and chin, or around the eyes in the case of periocular dermatitis. Moisturisers, cream cleansers, make-up foundation and sunscreens may all provoke perioral dermatitis.

Symptoms

Mostly spots develop on the skin as small red or pink. It can develop on the skin anywhere around the outside of the mouth. That is, it may appear on the chin, cheeks, and the skin next to and below the nose. The areas most affected are within the borders of the lines from the nose, to the sides of the lips, and the chin.  There is frequent sparing of a small band of skin that borders the lips. 

Treatment

A doctor is likely to diagnose perioral dermatitis based on the skin's appearance. No tests are usually done. In some cases, a culture for bacteria may be needed to eliminate the possibility of infection.

There is no medicine that you can apply directly to the skin which will help perioral dermatitis. A mild soap or soap substitute, such as Dove or Cetaphil should be used for washing. Scrubbing should be avoided. Try stopping fluorinated toothpaste for stubborn cases. Non-fluorinated toothpaste is available at a health food store. Some people successfully treat this kind of rash by using tea-tree oil as a gel or cream when they prefer a more natural approach.

Using a particular type of steroid cream to treat a rash on the face that doesn't actually need steroid cream often triggers perioral dermatitis.
All the while the oral antibiotic is continued until the rash has been absent for at least a month. Only then is the oral antibiotic also tapered off. It is extremely important that during this treatment period all facial creams (yes all!), except one moisturizer must be gradually stopped.

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