Last reviewed: January 2024
Author: Dr Francisco Flores; Dr Brittany Tsai; and Dr Maryam Ameen, Dermatologists, Ross University School of Medicine (January 2024)
Reviewing dermatologist: Dr Ian Coulson (2024)
Edited by the DermNet content department
A 33-year-old female presented with numerous small pink scaly papules and diffuse erythema at the left nasolabial fold, the right lateral chin, and upper lip for the past five years. She reported symptoms of itching, pain, discomfort, and redness exacerbated by stress and heat, and relieved by rest. The papules intermittently developed into pustules during acute flares of her condition. Of note, the patient regularly worked in a hot warehouse.
A 0.2 cm punch biopsy of the inferior cutaneous right lip revealed acute suppurative inflammation with bacterial colonies, and no carcinoma was identified. Skin swabs showed normal skin commensals.
This is chronic perioral dermatitis. It usually consists of erythematous papules arranged around the chin and nasolabial folds. Similar lesions may develop at the outer canthi. Occasionally pustules develop, and it may be mistaken for a bacterial infection or acne. In the latter condition comedones (blackheads and whiteheads) are present.
In perioral dermatitis, topical products, especially topical steroids, should generally be stopped as they can worsen the condition. Mild cases may resolve with this ‘zero-therapy’ approach. In moderate or severe cases, oral tetracycline antibiotics result in rapid resolution and a gratified patient! Topical pimecrolimus is an alternative.
This patient was prescribed trimethoprim as she was allergic to tetracyclines, and instructed to use gentle facial products, avoid fragrances and sun exposure, and refrain from using topical steroids.
See: Periorificial dermatitis.
