Perioral dermatitis caused by steroid cream

Generally, this skin rash will not disappear without treatment and can last for years. Treatment of this face skin problem is required to eliminate it. The first treatment step is to eliminate the use of products that are suspected triggers of the rash around the mouth. Oral or topical antibiotics are used and sometimes in combination with mild corticosteroid cream application to reduce redness and inflammation of the skin. Care must be taken when using the steroidal creams because they may make the mouth rash worse. The antibiotic treatment may have to be continued for up to three months. Like antibiotic treatments for other health problems, the complete treatment needs to be fully completed to eliminate the risk of perioral dermatitis reoccurring.

Perioral dermatitis is a common and often chronic dermatosis. In its classic form, it primarily affects women aged 15 to 45 years, but there are also variants including lupus-like and granulomatous perioral dermatitis, where granulomatous form is more common in childhood and affects mostly prepubescent boys. The etiopathogenesis of the disease remains unclear, but there is a frequent finding of prolonged use of topical products, especially corticosteroids, in the treatment of rosacea and seborrheic dermatitis, preceding the clinical manifestation of perioral dermatitis. Other causes important for the occurrence of the disease include various skin irritants, as well as other physical and hormonal factors, which all share the epidermal barrier dysfunction as an underlying main pathogenic factor. Clinical presentation of papulovesicular eruption in the perioral region with a typical narrow spared zone around the edge of the lips is characteristic. Therapeutic approach should be individually addressed, depending on the severity of clinical presentation and patient's age, with special attention to patient's education and continuous psychological support. In mild forms of perioral dermatitis, 'zero therapy' is the treatment of choice. In the initial treatment period, patients with steroid-induced perioral dermatitis should be closely followed up because the rebound phenomenon usually develops after cessation of previous topical treatment. In moderate disease, treatment includes topical metronidazole, erythromycin, and pimecrolimus, whereas in more severe cases the best validated choice is oral tetracycline in a subantimicrobial dose until complete remission is achieved. Systemic isotretinoin should be considered as a therapeutic option for patients refractory to all standard therapies.

References:
American Academy of Dermatology. ”Contact dermatitis.” Medical Student Core Curriculum. Last update July 2011.
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Katta R, Schlichte M. “Diet and dermatitis: Food triggers.” J Clin Aesthet Dermatol . March 2014;30-36.
Nguyen JC, Chesnut G, et al . “Allergic contact dermatitis caused by lanolin (wool) alcohol contained in an emollient in three postsurgical patients.” J Am Acad Dermatol . 2010;62:1064-5.
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Perioral dermatitis caused by steroid cream

perioral dermatitis caused by steroid cream

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