This pathology presents itself as an "erythematous eruption, characterized by small papules and dry skin. In some respects, perioral dermatitis is similar to acne and / or rosacea, but differs from these conditions, respectively, by the absence of comedones and the localization of lesions.
The triggering causes of perioral dermatitis are not yet fully known, but a close correlation has been found with the prolonged application of topical corticosteroids and the use of cosmetics containing potentially irritating substances.
The management of perioral dermatitis consists of systemic and / or topical drug therapy, in combination with the prevention of triggering factors.
erythematous, papular-pustular, similar to acne and / or rosacea.
As can be guessed from the term "perioral", this form of dermatitis typically begins around the mouth.
Perioral dermatitis is mainly observed in women.
.One of the hypotheses advanced argues that the long-term use of some substances, such as topical corticosteroids and some cosmetics, are able to induce small alterations in the structure of the facial skin. This could make the skin surface more vulnerable to environmental factors. (wind, cold, sunlight, etc.) or other potential irritants.
According to other scientific sources, perioral dermatitis could be of neurogenic origin: some nerve cells locally release pro-inflammatory substances helping to trigger the skin rash. Other proposed mechanisms concern the overgrowth of some microorganisms on the skin.
Perioral dermatitis: predisposing factors
As anticipated, the causes of perioral dermatitis have not yet been defined with certainty. However, some factors have been identified that can contribute more to the "onset of the disorder: most of the time, at the root of the problem, there is not a single responsible mechanism, but a set of contributing causes capable of inducing the dysfunction of the barrier. epidermal and activation of the immune system, resulting in inflammation.
Among the factors most accredited as triggers of perioral dermatitis are:
- Topical corticosteroids (creams, ointments and gels): the excessive and prolonged use of these drugs is related to the onset of perioral dermatitis, but it is not clear what is the correlation between the risk of developing inflammation and the concentration of the drug or Duration of treatment Perioral dermatitis has also been reported after use of corticosteroid inhalers and nasal sprays.
- Fluoride toothpastes.
Potential risk factors also include the use of poor quality cosmetic products for skin care (moisturizers, physical sunscreens or cleansers) and / or containing irritants, such as sodium lauryl sulfate (SLS), isopropyl myristate, petroleum jelly and paraffin.
Furthermore, the following could participate in the onset of perioral dermatitis:
- Hormonal imbalances: perioral dermatitis can worsen in the period preceding the onset of menstruation;
- Contraceptive pill;
- Infectious agents of various kinds and altered skin microflora (eg. Bacillus fusiformis, Demodex folliculorum And Candida albicans);
- Intestinal disorders (eg malabsorption of various kinds, positivity for Helicobacter pylori);
- Particular climatic factors, such as exposure to strong wind, heat or ultraviolet rays;
- Stress and mood swings.
Perioral dermatitis: who is most affected?
Perioral dermatitis is a typically female disorder; this inflammation mainly affects women between the ages of 20 and 45.
Less often, however, perioral dermatitis affects children and men.
they begin at the level of the nasolabial folds and, subsequently, tend to extend around the mouth and can also involve the chin and part of the cheeks. Perioral dermatitis, on the other hand, spares the lip contour area (ie the so-called vermilion), just as the inner part of the mouth is not affected by inflammation.
Erythematous papules are similar to those that form when you have acne. Less often, the skin rash of perioral dermatitis consists of pustules and papulo-vesicles (lesions with serous or purulent contents).
- Itching
The onset of actual erythema may be anticipated by an itchy sensation. This may be one of the initial symptoms of perioral dermatitis, but it is not always present.
- Dryness of the affected area, with or without peeling
In the area of the chin, the nasolabial folds and the lip filter (between the upper lip and the nose), reddish spots with sharp borders may appear. These signs of perioral dermatitis appear dehydrated and finely flaking. Additionally, these red, dry patches are associated with burning, itching, or aching sensations.
Variants of Perioral Dermatitis
The rash that characterizes perioral dermatitis can also spread to the forehead, cheekbones and periorbital region.
Perioral Dermatitis: What Can Exacerbate or Worsen Symptoms?
Topical corticosteroids worsen the symptoms of perioral dermatitis, so contact of the area around the mouth with hot or cold foods and direct exposure to the sun, wind and low temperatures can be bothersome. Infections can complicate this picture.
.
Differential diagnosis should exclude seborrheic and contact dermatitis.
they make the situation worse.
Medicines and other therapeutic interventions
In the event that the perioral dermatitis is sustained by a "bacterial infection, drug therapy involves the use of antibiotics:
- Topical, i.e. to be applied locally, such as erythromycin or metronidazole;
- Orally, like tetracyclines.
When perioral dermatitis depends on a hormonal dysfunction, it will be necessary to intervene, on the other hand, from an endocrinological point of view, to restore balance.
In some cases of perioral dermatitis, especially the more serious ones, there are some treatments that can give good results; if he deems them suitable, the doctor will advise them.
These include:
- Isotretinoin: it is effective in particularly resistant cases of perioral dermatitis, as it counteracts the production of substances responsible for the typical lesions of the disease. This drug is taken orally, in the form of tablets. The use of isotretinoin is contraindicated in pregnancy.
- Pimecrolimus: it is a valid remedy especially for the irritation caused by the application of steroid ointments; helps to significantly reduce the inflammatory state of the skin.
- Benzoyl peroxide: it can be useful, but in some cases it can worsen the dryness of the skin.
In the treatment of perioral dermatitis, photodynamic therapy may also be useful.
Remedies
As for natural and home remedies, it is possible to reduce the redness of perioral dermatitis by applying cold compresses of chamomile infusion.
Some advice
- Once the problem has been solved, to prevent it from recurring, it is advisable to avoid applying cosmetics on the perioral area that contain potentially irritating substances such as paraffin, petroleum jelly, isopropyl myristate and sodium lauryl sulfate.
- If identified well during the diagnostic process, avoid individual triggering factors.
- To wash the face it is good to use, as long as perioral dermatitis is present, only warm-hot water.
