Perioral dermatitis: causes, symptoms and drugs for treatment

Often, patients with rashes on the skin of the face or other parts of the body and limbs, for a number of reasons, resort to treatment on their own, purchasing creams or ointments at the pharmacy recommended by a pharmacist, a friend, or found on the global Internet. These funds may be useless, but they are not always harmless. It’s good when the drugs helped and did not have any side effects. However, long-term use without the advice of a doctor of external products, mainly on the skin of the face, which contain a hormonal (or more correctly, glucocorticosteroid) component, can lead to the development of such complications as perioral dermatitis, when the rashes are located around the mouth. With the correct prescription and mode of use, there is no need to be afraid of hormonal (glucocorticosteroid) drugs; today they have a high level of safety.

Perioral dermatitis

Perioral dermatitis on the face is a disease that affects the skin.
It appears in the form of small pimples that form in the area of the lips and mouth. It is accompanied by unpleasant itching, redness and negative consequences, which can be eliminated through a medical examination and properly selected treatment. In each specific situation, based on the results of the consultation, doctors recommend the patient medications that are relevant to his case. These include specialized pastes, ointments, sometimes hormonal drugs, as well as therapy that quickly eliminates burning and other symptoms. For perioral dermatitis, medications (ointment, tablets, cream) are selected based on medical diagnosis and tests. You can purchase the necessary medications for treatment on our website “Pharmacy 911”.

Contact dermatitis - symptoms and treatment

Symptoms of simple contact dermatitis:

soreness;
redness;
burning;
edema;
itching (less pronounced).

Sometimes blisters with clear serous fluid appear, which can burst. As a result, weeping occurs in the area of dermatitis - fluid separation. If an infection is added to the irritation, pustules appear.

Scalp

On the scalp, dermatitis develops with increased sensitivity to certain metals, in particular nickel. Products made from it (for example, curlers, hair straighteners) can cause redness and itching. Hair washing products can lead to the development of “washing dermatitis”, which appears as strip-like lesions on the face and neck. Other causes of dermatitis are accessories with rubber or leather parts: hat band, cap lining, wig patch [5].

Face

Dermatitis can be caused by the use of cosmetics: moisturizers and sunscreens, hair care products, perfumes. Mobile phone use can cause dermatitis in the form of a unilateral rash on the cheek [6][7].

Eyelids

Sensitivity of the skin in the eyelid area often causes the appearance of dermatitis in this area. Dermatitis can be caused by the prescription of eye drops and the use of objects containing rubber, such as swimming goggles and microscope eyepieces. [8]. If you rub your eyes with your hands, “accidental” allergens can get on your eyelids.

Mouth, lips

The causes of damage to the oral cavity are dentures, crowns, and hygiene products. Nickel, cobalt, mercury, and gold are used to make dentures. These substances can cause burning and tingling sensations in the mouth [8][9]. An allergic reaction occurs to chemicals, flavorings contained in toothpastes and other oral care products. Sodium lauryl sulfate, which is part of toothpastes, often causes irritation.

Lip dermatitis is associated with the application of lipstick, which contains dyes, flavors, and preservatives. Another cause of lip dermatitis is the habit of putting metal objects in the mouth, in particular pens and pencils. Chronic dermatitis in the form of a plaque on the lower lip can develop in musicians who play wind instruments.

Neck

The use of cologne and perfume leads to rashes on the front surface of the neck. Photoallergic dermatitis of the face and neck can be caused by sunscreen agents. A rash in the form of a strip around the neck appears from contact with the collar of a shirt or coat if the allergen is part of paints and resins. Allergic dermatitis develops from contact with metal, which is part of jewelry - chains, necklaces. The lesion will correspond to the location of the decoration [13][14].

Hands, feet, limbs

Dermatitis can develop through daily contact with water, detergents, and the use of rubber gloves. There is palmar grip dermatitis, which affects the central part of the palm in contact with the allergen. The causes of such dermatitis are a mobile phone, a gear shift in a car, gripping a cane and other objects [2].

Hairdressers experience rashes due to the use of shampoos, hair dyes, and nickel-plated scissors [15]. If the periungual ridges on the fingers become inflamed, exposure to formaldehyde resin or acrylate in nail polish and artificial nails can be suspected.

Typical allergens that cause foot dermatitis are rubber vulcanizers in rubber, tanning agents, rosin, chromates, such as potassium biochromate in leather [16][17].

The upper and lower extremities are exposed to irritants and allergens [2]. Dermatitis is localized on the wrists, thighs, and calf muscles.

Torso

Dermatitis of the trunk is common, but it is not always possible to determine the source of the allergens. Rash on the abdomen and back occurs when wearing belts with buckles and bras with clasps containing nickel. Nickel can cause dermatitis on the left side of the chest if a man carries a lighter or other item containing this metal in his chest pocket.

In the armpits, dermatitis appears when using deodorants that contain fragrances, essential oils, propylene glycol, and parabens.

Clothing can be a source of allergens. Rashes occur during intense sweating and are located in areas of friction between the skin and clothing. The causes of contact dermatitis are both the fabric itself and the dyes used in its production [20]. In recent years, it has been associated with dimethyl fumarate. The substance is used as a biocide to prevent the growth of mold and is found in fabrics covering sofas [21]. This type of dermatitis is severe and affects the back, buttocks, and lower limbs.

Causes of perioral dermatitis

Various factors become prerequisites for the occurrence of the disease. It is generally accepted that the disease can occur in waves, during which the irritation on the skin passes and reappears. Doctors often identify hormonal changes as the cause of perioral dermatitis. Symptoms appear as a result of:

the use of drugs based on corticosteroids, which provoke the occurrence of rosacea, acne, blackheads and other cosmetic problems
pregnancy, when the body is at the stage of serious changes and hormonal changes. Dermatitis often worsens before the onset of menstruation.
using inappropriate decorative cosmetics
the use of pastes with fluoride, which provoke irritation of the epidermis
chapping after walking in the cold or sunbathing
infectious diseases
problems with immunity. They are usually caused by not getting enough vitamins.

Having discovered a corresponding problem, it is better to immediately go to see a doctor and find out how to treat perioral dermatitis on the face in adults.

Treatment of atopic dermatitis in children

In this article, we will pay great attention to the treatment of this disease, and will also talk about the main features of the use of medications in children with atopic dermatitis.

The basis of treatment is external therapy using various medications. The goal of external (local) therapy is the complete elimination of inflammatory changes, itching, as well as restoration of the water-lipid layer of the skin. Local glucocorticosteroids (hormones), calcineurin inhibitors, and emollients are used as such agents. We will pay special attention to emollients. Emollients are medicinal cosmetics that care for the skin and prevent dry skin. In some cases, systemic therapy is also prescribed. Systemic therapy refers to the use of drugs that are administered orally. Antihistamines are most often used as systemic therapy.

Below we consider the most common drugs for the treatment of blood pressure in children.

The goal of local therapy for atopic dermatitis is the complete elimination of inflammatory changes and itching.

Hormones

Local glucocorticosteroids (MGS) are used as hormones. They are the most powerful drugs at the onset of the disease, which allows the symptoms of this disease to be eliminated in the shortest possible time. The duration of use of these drugs should not exceed two weeks. If possible, use of MGCs should be short.

What parents should remember when using these products:

It is not recommended to mix MHA with other agents.
When the symptoms of the disease decrease, it is necessary to reduce the amount and frequency of MHA use.
In the event of a bacterial or fungal infection, it is necessary to use a combination of MHA with antibacterial and antifungal drugs.
Do not apply these medications under closed dressings.
With long-term use, complications may develop. Such complications include: stretch marks, telangiectasia, skin atrophy. Striae are white to pink stripes on the skin. Telangiectasia is popularly called “spider veins”. This complication is a vascular formation with dilated vessels. Atrophy is characterized by a skin defect with a change in its volume and elastic properties.

Local hormones exist in different classes, depending on the strength of their action. The most common MGCs are: celestoderm, elokom, lokoid, dermovate, cutivate.

Calcineurin inhibitors (CI)

A special feature of these drugs is the absence of complications inherent to hormones. They can be used together with hormones. After eliminating symptoms, MGC can be replaced with IR, which will avoid the development of complications. The two most common medications in this group are pimecrolimus and tacrolimus. Pimecrolimus is used for mild cases, while tacrolimus is used for severe cases.

Symptoms of the disease

The first sign that you need to undergo an examination is the appearance of small blisters (papules) in the mouth and chin. In severe cases, they can spread throughout the face, reaching the cheeks, nose, eyes and temples. Papules are filled with clear liquid. Color varies from flesh-colored to pink to bright red depending on the stage of the disease. Pimples appear singly or in groups. The skin in these areas becomes rough. Bursting, papules form crusts. If you accidentally touch one, pigmentation will eventually remain on the skin.

Patients do not always experience serious pain. The sooner treatment of perioral dermatitis on the face in children and adults begins, the easier it is to get rid of the disease, and the lower the risk of unpleasant consequences. When you notice the first symptoms of the disease, make an appointment with a dermatologist.

Risk groups and similar diseases

Signs of the disease are most often found in women, but children and adolescents periodically experience them due to weakened immunity. In place of the blisters, ulcers often form. When spread over the entire face, it becomes a threat to vision, which is especially important in the situation with children. Therefore, when checking with a specialized doctor about how to treat perioral dermatitis in children, it is worth paying a visit to an ophthalmologist.

In the case of teenagers, the disease may not be detected immediately, because, experiencing hormonal changes, boys and girls often encounter skin problems. Blackheads and acne affect most people, so it can be difficult to notice papules at an early stage. Patients prone to allergies also rarely accurately diagnose the disease. Perioral dermatitis in children is often attributed to hormonal imbalance.

General notes on therapy

The choice of drug and treatment method for perioral dermatitis depends on the severity and stage of the disease.
For the period of treatment, regardless of the chosen method of therapy, stop using cleansing and moisturizing cosmetics, decorative cosmetics, fluoridated toothpastes, as well as external and systemic drugs containing glucocorticosteroids (when discontinuing systemic drugs containing glucocorticosteroids, it is necessary to take into account the indications for which the drugs were prescribed , the patient should be advised to consult the doctor who prescribed them regarding possible discontinuation of the drug). There are “zero”, external and systemic therapy for perioral dermatitis. For mild perioral dermatitis, “zero” therapy is sufficient, which consists of abolishing all external, including cosmetic, products, especially drugs containing glucocorticosteroids. Improvement occurs on average within 2 weeks. If it is ineffective, drug therapy is prescribed.

Indications for hospitalization

None.

Requirements for treatment results

Regression of rashes.
Prevention

limiting the use of drugs containing glucocorticosteroids;
limiting the use of cosmetics.

External therapy

Prescribed for mild to moderate severity of the disease, used as monotherapy, and for severe perioral dermatitis it can be prescribed in combination with systemic therapy:

Metronidazole, 1% cream 2 times a day externally for 8 weeks
azelaic acid, 20% cream 2 times a day externally for 2-6 weeks
pimecrolimus, 1% cream 2 times a day externally for 4 weeks

Note. In the instructions for medical use of azelaic acid and pimecrolimus, perioral dermatitis is not included in the indications for use of the drug.

Systemic therapy

Prescribed for severe forms of the disease, as well as when external therapy is ineffective:

tetracycline 250-500 mg 2 times a day orally for 4-8 weeks. Prescribed to patients over 8 years of age.
For tetracycline intolerance in pregnant women, children under 8 years of age and for granulomatous form of perioral dermatitis in children: erythromycin 250 mg 2 times a day orally for 1 to 3-4 months.

Note. In the instructions for medical use of tetracycline and erythromycin, perioral dermatitis is not included in the indications for use of the drug.

If antibacterial therapy is ineffective, isotretinoin 0.1-0.7 mg per kg body weight is prescribed orally once a day for 6-20 weeks.

Note. In the instructions for medical use of isotretioin, perioral dermatitis is not included in the indications for use of the drug.

Diagnosis of perioral dermatitis

Having noticed the first signs of the disease, having felt unpleasant symptoms, you need to make an appointment with a specialized specialist. The initial appointment with a doctor consists of an examination, a description of the medical history based on the patient’s complaints and information about the individual characteristics of his body and possible reactions.

Before treating perioral dermatitis, tests are one of the mandatory procedures. They allow you to identify the prerequisites for the development of the disease and accurately diagnose it, without confusing it with herpes, rosacea and other skin lesions. You will need:

Dermatoscopy. Gives an assessment of the epidermis and helps assess the course of the disease
Scrapings. Determine the infectious nature if the symptoms have a corresponding origin
Allergy tests. Demonstrate the level of skin sensitivity to staphylococcus and streptococcus

As a result of the examination, the doctor explains to the patient how to cure perioral dermatitis, clinical recommendations are entered into the disease record. A course of medications and therapy is prescribed.

How to get rid of dermatitis?

25.01.2021

Dermatitis is a fairly common skin disease. In medicine, the term “dermatitis” is a general name for many subtypes of various skin diseases: atopic, herpetiformis, seborrheic, etc.

Essence

Most often, the disease is expressed in a short-term effect of inflammation of the epidermis. It is quite easy, especially in the initial stages, to be completely cured. The disease is mainly divided into: taxidermy and contact dermatitis . Their difference lies in the degree of impact on the body. The contact form of dermatitis occurs upon contact with any substance and has purely external signs of the disease, while taxidermy has a more extensive internal effect on the body.

Kinds

Since the concept of dermatitis is quite general, in medicine today there are many subtypes of this disease. Here are some of the most common ones:

taxidermy;
allergic;
contact simple;
atopic cutaneous;
perioral and seborrheic.

Contact dermatitis

Caused by various external irritants when exposed to the surface layers of the skin. Factors that cause dermatitis can be of different nature and varying degrees of impact. For example, contact with chemicals or drugs can cause a short-lived inflammatory process in the absence of an irritant, which goes away on its own. Also, simple contact dermatitis can be caused by such factors as: temperature (hypothermia or overheating), pressure, friction, some plants (hogweed, nettle). Treatment in the case of simple contact dermatitis directly depends on the duration of exposure and the degree of damage to the skin.

Allergic skin dermatitis

The main difference between this type of dermatitis and simple contact dermatitis is the reaction of the epidermis to the irritant. With contact dermatitis, the reaction appears immediately, but it can take up to several weeks an allergic reaction And only upon repeated contact with the allergen do skin inflammations appear. The area of the injured area can be much larger than the contact area. With a long course of the disease, self-opening blisters form on the skin when it dries, which leave scales and crusts on the surface of the skin. dermatitis also called eczema .

Seborrheic and perioral dermatitis

This type of dermatitis has a chronic course and is formed mainly in those areas of the epidermis that have sebaceous glands: forehead, scalp, nasolabial folds, cheeks. Seborrheic dermatitis is caused by the yeast Malassezia. Almost all people are carriers of these microbes, so the disease cannot be called infectious. Our own immunity the best protector against seborrheic dermatitis . Therefore, the best prevention of seborrheic and perioral dermatitis is its strengthening.

Atopic dermatitis

It is a type of allergic dermatitis . The difference lies in the number of allergens that cause inflammatory processes on the skin. With atopic dermatitis there can be a lot of them, and the disease itself is genetic and, as a rule, has a chronic form.

To properly get rid of dermatitis, it is necessary to identify the source of infection, as well as determine the extent of the disease. After which the specialist will be able to prescribe a course of treatment.

Published in Dermatology Premium Clinic

Treatment of perioral dermatitis

A confirmed diagnosis usually requires an integrated approach. The treatment regimen involves a complete refusal of cosmetics, as well as corticosteroid drugs. The patient is advised to use antihistamines to relieve burning and itching. Herbal lotions are used to help reduce inflammation. Reflexology is used to stop symptoms by pressing on specific points or placing special needles.

Having weakened the symptoms, you can resort to the use of antibiotics to get rid of the infection if it is diagnosed during the examination. For perioral dermatitis, medications are prescribed by a doctor taking into account age, body characteristics, allergies and pregnancy. Strengthening the immune system and restoring the balance of intestinal microflora are important. The latter may require a specific diet. Avoid fried, spicy and fatty foods, snacks, sweets and fast food. Give up alcohol and cigarettes.

Prevention

Treatment with ointment for perioral dermatitis is not always a panacea. In some cases, the disease can return, so the course of taking medications can be long. Any irritant often leads to the appearance of the disease. Following simple recommendations will help you avoid possible risks:

Check the composition of cosmetic products and treat their choice with special attention
Don't neglect personal hygiene
Strengthen your immunity
Eat right and monitor your digestive health
Be aware of allergies
Monitor hormonal balance during pregnancy, in case of possible changes due to nervousness, illness or other reasons

Perioral dermatitis detected at the first stage is the easiest and fastest to treat, so remain sensitive to the body’s signals and begin the fight against the first symptoms of the disease in a timely manner.

Bibliography

Adaskevich V.P. Perioral dermatitis: clinical picture, diagnosis, treatment / V.P. Adaskevich // Dermatology. – 2008. – No. 1. – P. 17–20.
Grashkin V. A. Diagnostic criteria, epidemiology and substantiation of clinical and pathogenetic types of perioral dermatitis / V. A. Grashkin, M. S. Gromov // Voenmed. magazine – 2010. – No. 10. – P. 32–45.
Rodionov A. N. Dermatocosmetology. Lesions of the facial skin and mucous membranes. Diagnostics, treatment, prevention / A. N. Rodionov. – St. Petersburg. : Science and technology, 2011. – 912 p.
Karelina O. Yu. Perioral dermatitis: treatment with azelaic acid / O. Yu. Karelina, Yu. M. Karelin // Klin. dermatology and venereology. – 2006.

Clinical manifestations of dermatitis

Perioral dermatitis most often affects women, mainly aged 20-30 years. Clinically, it manifests itself as a rash against the background of inflamed skin, most often located around the mouth, and somewhat less often - the nose and eyelids. A distinctive feature of dermatitis is the presence of a light rim of unaffected healthy skin around the lips; in severe forms, swelling may occur. This dermatitis can resolve on its own when the causative factor is eliminated or become chronic, which significantly reduces the quality of life.

Facial skin dermatitis or consequences of incorrect treatment