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Erythematous rash on face

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Diagnosis: Perioral dermatitis

Perioral dermatitis occurs in men and women of all ages and races, though it is more common in women between the ages of 16 and 45.1,2 Many agents have been implicated in the etiology of perioral dermatitis, including infectious pathogens, hormonal factors, and steroids. Moisturizing creams and cosmetics, such as foundation and blush, can cause occlusion of skin follicles, leading to proliferation of skin flora and the resultant papulopustular rash seen in perioral dermatitis.3

In a similar manner, fluorinated corticosteroids enable opportunistic fusobacteria to become pathogenic, leading to the condition. Other risk factors include premenstrual hormone changes, pregnancy, and the use of oral contraceptives, fluorinated toothpaste, inhaled steroids, or glucocorticoids.4

It’s easy to distinguish from these 3 conditions

The differential diagnosis includes contact dermatitis, atopic dermatitis, and rosacea.

  • Contact dermatitis is similar to perioral dermatitis in that the patient may indicate that she started using a new skin product. In most cases, the pruritus associated with contact dermatitis will aid in differentiating the 2 diagnoses.
  • Atopic dermatitis is more common in children and rarely has an adult onset. Often, there is a personal or family history of asthma or allergies. Distribution in adults is more typically on flexure surfaces, hands, and upper eyelids, and it is itchier than perioral dermatitis.
  • Rosacea is often associated with flushing, and is exacerbated by the ingestion of hot food and drinks, alcohol (red wine), and exposure to sun. The distribution is typically on the forehead, cheeks, nose, and around the eyes—rather than around the mouth.

A rash that’s painful and mildly itchy
Perioral dermatitis has distinct clinical features that distinguish it from other facial dermatoses. The rash is classically described as tiny, dry, erythematous papulopustules in a pattern around the mouth, nasolabial folds, and chin, with sparing of the vermilion border.1,2 The clinical course is variable, but is often chronic, with flares. Typically, the rash is only mildly pruritic, but a burning or painful sensation is common. Intolerance to sunlight, drying agents (such as soaps), or irritants (such as cosmetics) is also common.3

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