Perioral dermatitis (PD) indicates a rash confined around the mouth sparing a narrow clear band around the vermilion border.

This disorder is characterized by lesions typical of acne and eczema. There are sometimes small reddish acne-like bumps or pustules, sometimes the skin is red, dry and scaly, sometimes equal attributes of both. Subjective symptoms consist above all of burning. Itching is rare. Other locations of PD are nasolabial folds next to the nose and lateral to the lower eyelids.

PD most commonly affects women (90% of cases). This could be related to the use of cosmetics. If so, it would be better to avoid the use of the following substances:

• Petrolatum

• Paraffin

• Sodium lauryl sulphate

• Isopropyl myristate

The pathogenesis of PD is unknown. Etiopathogenetic options are:

• Some types of cosmetics

• Prolonged use of steroid creams

• Residue from asthma inhalers that contain steroids

• Dental products with fluoride

• Hormones

• Tartar control ingredients

• Cinnamon flavouring (gum, candies, oral care products).

• Candida infection

• Helicobacter pylori

• Fusiform bacteria

• Demodex folliculorum

• Intestinal malabsorpion

Often the dermatologist, at the time of the first visit, ascertains that the patient has made prolonged use of strong corticosteroid creams. These creams seem to help but the disease come back even worse with intense erythema each time steroid cream is stopped. So the patient continues to use it with remissions and flares up often worse than it was before, in a chronic way. The reason of it is that the skin becomes addicted to these high potency topical steroids; so it is extremely difficult to convince the patient to give up the cream because whenever the cream was attempted, the disease rebounded. Besides overtreatment, the strong steroid cream induces a thinning (atrophy) and fragility of the skin with evident spider veins.

Ultraviolet light worses PD.

Stopping the steroid cream it will be 2 weeks to wait out the rebound. To avoid the patient reapply the offending cream and to reduce the intensity of the rebound, it needs to start immediately appropriate PD therapy.

The treatment of PD consists of oral antibiotics (tetracycline and derivates, erythromycin, isotretinoin, azitromycin). Topical treatment (metronidazole, erythromycin, tacrolimus, pimecrolimus, azelaic acid, adapalene) should be used with particular attention, because of the extreme sensibility of the affected skin.

While the rash is present , it would be better to wash the face only with lukewarm water. When the rash has cleared up, simple gentle cleanser is the recommended detergent. Never wash the face with soap because of its alkalinity and its ability to leave deposits of carbonate salts onto the skin that irritate it.

Make-up is to shelve. To avoid dental-care products containing fluoride, tartar- control ingredients or cinnamon.

If intolerance to cosmetics is suspected, a therapeutic option should be the so-called “zero-therapy” that is based only on the elimination of cosmetics, without any treatment. This approach is appropriate in very compliant patients.

Photodinamic therapy with ALA and blue light is a new recent option.

PD tends to be chronic if not treated.