Derm Dx: A rash about the mouth and chin - Clinical Advisor

Derm Dx: A rash about the mouth and chin

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A 21-year-old woman presents for evaluation of a rash about her mouth and chin. The dermatitis has been waxing and waning in intensity for approximately 2 years. It clears when treated with oral prednisone and then flares shortly after discontinuation. Examination reveals erythema and tiny pustules. She is currently applying mometasone cream to the affected areas.

Perioral dermatitis appears as erythematous papules and pustules limited to the nasolabial folds and the skin of the chin. It can occur as a chronic condition, recurring over weeks to months.1 Perioral dermatitis primarily affects females aged 15 to 45...

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Perioral dermatitis appears as erythematous papules and pustules limited to the nasolabial folds and the skin of the chin. It can occur as a chronic condition, recurring over weeks to months.1 Perioral dermatitis primarily affects females aged 15 to 45 years.2 The cause of perioral dermatitis is not clear; however, prolonged use of topical steroids, especially corticosteroids, may precede the occurrence and then exacerbate the clinical manifestation. The use of skin irritants is also associated with the condition, and there is a female sex predominance.2 The differential diagnosis for perioral dermatitis includes seborrheic dermatitis, systemic lupus erythematosus, acne vulgaris, and steroid-induced rosacea.1

Management of perioral dermatitis includes avoidance of fluorinated steroids, which result in temporary improvement followed by exacerbation.3,4 Topical therapies include clindamycin, metronidazole, and the calcineurin inhibitor pimecrolimus. More severe cases may require oral antibiotics for adequate control.

John Pappas, BS, is a medical student at the Geisinger Commonwealth School of Medicine in Scranton, Pennsylvania. Stephen Schleicher, MD, is an associate professor of medicine at the Commonwealth Medical College in Scranton, Pennsylvania, and an adjunct assistant professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. He practices dermatology in Hazleton, Pennsylvania.

References

  1. Lipozencic J, Ljubojevic S. Perioral dermatitis. Clin Dermatol. 2011;29:157-161.
  2. Mokos ZB, Kummer A, Mosler EL, Čeović R, Basta-Juzbašić A. Perioral dermatitis: still a therapeutic challenge. Acta Clin Croat. 2015;54:179-185.
  3. Tempark T, Shwayder TA. Perioral dermatitis: a review of the condition with special attention to treatment options. Am J Clin Dermatol. 2014;15:101-113.
  4. Hall CS, Reichenberg J. Evidence based review of perioral dermatitis therapy. G Ital Dermatol Venereol. 2010;145:433-444.
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