Perioral dermatitis is a chronic inflammatory lesion of the skin around the mouth in the form of separate or grouped red papules located against the background of normal or reddened skin. Diagnosis is carried out by a dermatologist during examination and dermatoscopy. The sowing of scraping or separating elements is carried out. Treatment of perioral dermatitis consists of two stages. First, corticosteroids and cosmetics are canceled, and then systemic antibacterial therapy is prescribed.
L71.0 Perioral dermatitis
The most common perioral dermatitis is observed in women aged 20 to 40 years. Recently, there has been an increase in the incidence of this type of dermatitis among children. In modern dermatology, there are still debates about the expediency of separating perioral dermatitis as a separate disease. Some experts consider it a clinical form of seborrheic dermatitis or rosacea.
The exact causes of perioral dermatitis are not yet known. In many cases, the disease occurs in patients after prolonged use of topical medications containing corticosteroids. At the same time, local therapy with glucocorticoids was prescribed during the treatment of various diseases with facial skin lesions: acne, rosacea, inverse acne, eczema, etc.
Severe weathering of the facial skin, increased insolation, the use of fluoride-containing toothpaste and decorative cosmetics such as makeup base and foundation can provoke the development of perioral dermatitis. In women, the disease is associated with hormonal changes: the appearance of rashes during pregnancy and against the background of various gynecological diseases, increased manifestations of dermatitis before the start of the menstrual cycle. In some cases, perioral dermatitis appears when using oral contraceptives.
Rashes of perioral dermatitis are single or grouped typical spherical papules. They are colored red or red-pink and are located on the background of reddened or unchanged skin. Rashes may be accompanied by discomfort, a feeling of tightness of the skin, burning or itching. But in about 25% of cases, patients do not notice any subjective sensations.
Depending on the severity of perioral dermatitis, its clinical picture may look like individual pinkish papules against the background of normal skin or look like a zone of hyperemia with many bright red rashes. A large number of papules make the skin rough when stroking. Papules can resolve with the formation of crusts, premature removal of which can lead to hyperpigmentation.
Rashes with perioral dermatitis are located on the chin, under the nose, in the nasolabial folds, in the corners of the mouth. Occasionally there is a periorbital form of the disease with lesions of the skin of the corners of the eyes, lower and upper eyelids, and the bridge of the nose. Approximately half of the cases of perioral dermatitis occur in a mixed form, in which rashes are localized not only around the mouth, but also on other parts of the face. In most patients, the skin directly near the red border of the lips remains unaffected, forming a pale rim up to 4 mm wide around the lips.
Perioral dermatitis is diagnosed during dermatological examination and dermatoscopy. At the same time, it must be differentiated from various types of acne, eczema, herpes simplex, rosacea, demodecosis.
To isolate the microflora, the contents of the rashes or scraping from the lesion site are seeded. At the same time, increased skin contamination, the presence of Candida and Demodex folliculorum fungi are often detected. However, a specific pathogen, uniform for all patients with perioral dermatitis, has not yet been detected.
Skin tests with allergens of staphylococci and streptococci reveal the presence of sensitization to bacterial agents in patients. Histological examination of skin samples from the affected area is not used due to the nonspecificity of the histological picture, in which signs of subacute inflammation with areas of epidermal atrophy are observed.
The first stage of treatment consists in the cancellation of any drugs containing corticosteroids in their composition. At the same time, in most patients with perioral dermatitis, “withdrawal dermatitis” is observed after a few days. It is characterized by pronounced redness and swelling in the areas of skin lesions, intense burning and itching. Such manifestations often frighten patients, make them want to return to the use of corticosteroids. But a return to corticosteroids is unacceptable, because it only leads to a heavier process.
At the first stage of treatment, a patient with perioral dermatitis needs full confidence in the treating dermatologist, discontinuation of the use of cosmetic products, compliance with a hypoallergenic diet. In local treatment, it is permissible to use only herbal lotions and photoprotective agents. To relieve itching and burning, patients are prescribed antihistamines: loratadine, chloropyramine, mebhydroline, etc. In some cases, sedatives are required. Reflexotherapy is possible.
After the symptoms of “withdrawal dermatitis” subside, they proceed to the second stage of treatment of perioral dermatitis. It consists in prescribing to the patient a course of antibacterial therapy with tetracycline antibiotics (monocycline, doxycycline) or metronidazole. The duration of therapy depends on the severity of the process and can take up to 8-12 weeks.