Perioral Dermatitis
(Periorificial Dermatitis)

• Definition
  
• Clinical Features
  
• Variants
  
• Pathogenesis
• Diagnosis and Differential Diagnosis (see Table)

• Definition:  an inflammatory disorder of the skin usually localized to the skin around the mouth, but sparing a rim at the vermilion border
  

• Clinical Features
  • Usually occurs in young adults, mainly but not exclusively in females
  • Distribution is primarily on the chin and upper lip with involvement occurring also in the nasal labial folds and around the eyes
  • May be mild itching and burning sensation
  • Individual lesions consist of papules or pustules which often coalesce to form a confluent plaque
    
    
• Variants
  • Are relatively uncommon but involvement may be more asymmetrical around the mouth, and may also be more dominant around the eyes and around the mouth
    
    
• Pathogenesis
  • Like rosacea, is not understood
  • A convincing association has been made with the previous use of fluorinated topical steroids
  • Whether or not this is causative or merely an important aggravating factor, it is important to inquire about the possibility in the history
    
    
• Diagnosis
  • Clinical picture is quite typical
  • Again, the absence of comedones is a critical feature
    
    
• Differential Diagnosis (see Table)
  • Distinction from rosacea is on the basis of distribution but may be difficult
  • Some confusion with seborrheic dermatitis may arise but the presence of pustules and papules excludes this
  • Conversely, the presence of significant erythema and scaling within the scalp or at the hairline is against rosacea