What are the different causes of perioral dermatitis (POD)?

Updated: Aug 16, 2019
  • Author: Hans J Kammler, MD, PhD; Chief Editor: William D James, MD  more...
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Answer

An underlying cause of the perioral dermatitis (POD) cannot be detected in all patients. The etiology of perioral dermatitis is unknown; however, long-term use of topical steroids for minor skin alterations of the face often precedes the manifestation of the disease. Note the following:

  • Drugs: Many patients abuse topical steroid preparations. [2] No clear correlation exists between the risk of perioral dermatitis and strength of the steroid or the duration of the abuse. Perioral dermatitis has also been reported after the use of nasal steroids [3] and steroid inhalers.

  • Cosmetics: Fluorinated toothpaste [4, 5] ; skin care ointments and creams, especially those with a petrolatum or paraffin base, and the vehicle isopropyl myristate are suggested to be causative factors. In an Australian study, applying foundation in addition to moisturizer and night cream resulted in a 13-fold increased risk for perioral dermatitis. The combination of moisturizer and foundation was associated with a lesser but significantly increased risk for perioral dermatitis, whereas moisturizer alone was not associated with an increased risk. Physical sunscreens have been identified as a cause of perioral dermatitis in children. [6]

  • Physical factors: UV light, heat, and wind worsen perioral dermatitis.

  • Microbiologic factors: Fusiform spirilla bacteria, Candida species, and other fungi have been cultured from lesions. Research from 2015 suggests to differentiate perioral dermatitis caused by rod-shaped bacteria (possible fusobacteria) and corticosteroid-induced rosacea. [7]

  • Miscellaneous factors: Hormonal factors are suspected because of an observed premenstrual deterioration. Oral contraceptives may be a factor.


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