Perioral dermatitis often responds to an emollient. Other times, a topical antibiotic is required. How does one differentiate between infectious and noninfectious perioral dermatitis in the absence of systemic symptoms?—JOANIE HOLM, RN, PNP, Brooklings, S.D.
Perioral (or periorificial) dermatitis presents as erythematous, scaly, tiny papules and papulopustules located primarily around the mouth; typically, there is a narrow zone of sparing immediately around the lips. Less commonly, the lesions also involve the chin, upper lip, nasolabial folds, and periocular areas. Symptoms often include an irritant sensation or burning pain; occasionally the lesions itch. Rare reports have demonstrated the presence of Candida or fusiform bacteria; however, perioral dermatitis is not likely to be caused by an infectious etiology. Perioral dermatitis occurs most commonly in women (aged 16 to 45 years), yet can appear in childhood and adolescence—often associated with the use of topical corticosteroids. Sun exposure, intensive washing with soap or other detergents, and excessive use of cosmetics can also aggravate this condition. Treatment involves topical therapies (e.g., metronidazole or erythromycin, azelaic acid, and occasionally pimecrolimus), oral antibiotics (e.g., doxycycline, minocycline, tetracycline, and erythromycin) or both (Int J Dermatol. 2003;42:514-517).—Philip R. Cohen, MD (148-12)