Perioral Dermatitis: It's Not Every Rash that Occurs Around the Mouth

Stefan G. Vanderweil; Nikki A. Levin

Disclosures

Dermatology Nursing. 2009;21(6):317-320, 353. 

In This Article

Clinical Presentation

POD is an inflammatory facial eruption, presenting as tiny monomorphic flesh-colored to erythematous papules, vesicles, or pustules around the mouth (see Figure 1), and in some cases involving the perinasal, glabellar, and periocular regions (see Figures 2 & 3). The area immediately adjacent to the vermillion border of the lips is characteristically unaffected. It should be noted that pediatric cases of POD may involve the limbs or trunk. Also, 26% of children lack the characteristic perioral involvement (Nguyen & Eichenfield, 2006). Comedones, nodules, cysts, and telangiectasia are not features of POD.

Figure 1.

Perioral dermatitis on the face of a middle-aged woman. Monomorphic erythematous papules are clustered around the mouth.

Figure 2.

Perioral dermatitis with perinasal involvement.

Figure 3.

Pediatric case of periorificial dermatitis. In this case, tiny erythematous papules are located around the right eye.

Patient history commonly involves the use of topical corticosteroids. In some cases, patients may report a history of a mild facial rash medicated with moderately potent topical corticosteroids. While the use of these medications may provide transient relief, discontinuation is often accompanied by flare-ups of the rash. POD often follows a chronic, fluctuating course and may be exacerbated by overuse of moisturizers, cosmetics, and topical creams.

Variants of POD can be found in children. Granulomatous periorificial dermatitis (GPOD) consists of monomorphic small papules affecting perinasal, perioral, and periocular skin and is typically found on children with dark skin (Tarm, Creel, Krivda, & Turiansky, 2004). Facial lesions may be flesh-colored, yellow, hyperpigmented, or erythematous often with scaling and erythema. GPOD has a characteristic histopathology, with epidermal spongiosis and upper dermal and perifollicular granulomas surrounded by lymphocytes. Facial AfroCaribbean Childhood Eruption (FACE) has been described as monomorphic papules in perioral and periocular regions occurring in children and often resolving spontaneously (Williams, Ashworth, Pembroke, & Breathnach, 1990). FACE and GPOD are now thought to be the same disease.

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