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Perioral dermatitis: symptoms & therapy

by Josephine Andrews
Published: Last Updated on 234 views

Perioral dermatitis (mouth rose, stewardess disease) is a red, inflammatory skin rash on the face, the exact cause of which is still unknown. The rash resembles acne or rosacea and usually appears around the mouth and chin. More rarely, perioral dermatitis affects the eyes or other parts of the face. Find out more about the inflammatory rash, possible triggers of oral rhinitis and the treatment here!

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

L71

quick overview

  • What is perioral dermatitis? A chronic inflammatory skin disease affecting the face that is neither dangerous nor contagious.
  • Symptoms : red, often itchy rash around the mouth and chin – first with pimples around the mouth, then papules, pustules, plaques; less often other areas of the face are affected (such as forehead, around the eyes), in severe cases rash over the whole face and sides of the neck
  • Cause : unknown so far; Relationship between over-groomed skin and perioral dermatitis likely; Possible influencing factors: eg preparations containing cortisone (such as ointments), stress, gastrointestinal disorders, hormonal contraceptives, etc.
  • Treatment : for several weeks without care and cleaning products and cosmetics on the face as well as perfume and perfumed detergents, if necessary medication (with active ingredients such as zinc , antibiotics, isotretinoin ), household remedies (compresses with black tea), without stimulants (such as alcohol, nicotine), healthy, natural diet

Perioral dermatitis: definition

Perioral dermatitis (air hostess disease) is a rash usually limited to the facial skin around the mouth or chin. Because of the visual similarity to shingles, doctors often speak of mouth rose. The red, inflammatory lesions also resemble acne or rosacea . This is why the skin disease is also known as rosacea-like dermatitis.

The perioral rash on the face is usually chronic – either continuous or in flares (the symptoms are milder in the phases between flares).

The skin disease occurs primarily in younger women, usually between the ages of 20 and 45. Children are also often affected. Rarely do men develop facial dermatitis.

Perioral dermatitis is harmless and not contagious. It is primarily a cosmetic problem. In addition, the rash on the face can be a psychological burden for those affected.

Perioral dermatitis: symptoms

Perioral dermatitis primarily affects the skin around the mouth and chin, with a typically one to two millimeter wide rim adjacent to the red of the lips being spared from the skin changes. The fine, colorless vellus hairs whose follicles are affected in perioral dermatitis are absent here.

A first sign of the disease is a striking number of pimples around the mouth. In the further course, the following symptoms may appear:

  • itchy or burning reddening of the skin (erythema)
  • 0.2 to 0.4 cm large red nodules (papules), some with a yellow tip
  • scaly skin around the mouth
  • pustules around the mouth

Several pustules can merge into so-called plaques. The skin changes are blurred on the lateral parts of the face and end with papules and scaly skin. Some patients also report a feeling of tightness in the skin.

Where does the rash appear?

The rash usually forms around the mouth and chin – often starting at the nasolabial folds ( folds between the nostrils and the corners of the mouth). However, the inflammatory skin changes can also develop on the forehead or, in severe cases, spread to the entire face and the sides of the neck.

Very rarely, the skin condition affects the eyelids or just the area around the eyes. Then one speaks of periorbital dermatitis.

In children, much more frequently than in adults, the rash forms additionally or exclusively around the nose (perinasal) and/or around the eyes (periocular).

Distinction from acne and rosacea

Unlike acne, perioral dermatitis does not produce blackheads or whiteheads (comedones).

Differentiating between mouth rose and rosacea is more difficult. However, rosacea does not cause a rash on the eye or around the mouth. In addition, this widespread skin disease is accompanied by other symptoms such as visible enlargement of the smallest blood vessels near the skin’s surface (telangiectasia) and sudden, patchy reddening of the skin (at first fleeting, later persistent).

Perioral dermatitis: causes

The exact cause of the rash around the mouth is not yet known. However, various factors are discussed that could be involved in the development of perioral dermatitis:

Over treated skin

In many cases, an association can be observed between excessive skin care and the occurrence of perioral dermatitis. The frequent use of care products (moisturizing cream, night cream, nourishing cream, etc.) and cosmetics seems to promote the onset of mouth rhinitis – the skin is over-cared for and over-moisturized, which disrupts its barrier function. It dries out as a result, is irritated and irritated, which changes the natural skin flora and thus leads to the characteristic inflammatory skin changes.

The use of cortisone-containing products on the face can apparently promote perioral dermatitis. In addition to cortisone ointments, for example, this also includes cortisone preparations for inhalation, such as those used in asthma therapy.

Other influencing factors

In addition, other factors are discussed as possible triggers of the rash on the face, including for example:

  • sunlight
  • hormonal contraceptives (ovulation inhibitors such as the pill )
  • Gastrointestinal disorders (such as constipation)
  • increased sebum production in the skin (seborrheic constitution)
  • fluoridated toothpaste
  • Colonization of the skin with certain fungi (Candida) or bacteria (such as fusiform spirilla)

Psychological stress may also promote the skin rash: stress weakens the immune system and makes the entire body more susceptible to diseases and germs. Perioral dermatitis can also be triggered by stress.

causes in children

The chronic rash around the mouth also affects children more often – girls more often than boys. As in adults, the exact cause of the disease is still the subject of research.

For example, an American study on the causes of mouth rhinosis in children showed that affected children often also suffer from other skin diseases: 29.3 percent of the affected children in the study also had neurodermatitis and 14.9 percent also had allergic asthma. Almost every tenth child with perioral dermatitis suffered from an allergy. Particularly striking: More than half of the children affected by perioral dermatitis (58.1 percent) had previously used external cortisone preparations.

In addition, experts suspect that – as in adults – excessive skin care can contribute to the development of perioral dermatitis in children.

In the case of smaller children, physical sunscreens with a high sun protection factor are also considered possible triggers: the mineral UV filters on the skin could promote the development of mouth rosy due to their “closing” (occluding) effect.

Perioral dermatitis: investigations and diagnosis

If you notice a change in your skin on your face, your family doctor is the first point of contact. He can assess the symptoms and will refer you to a dermatologist if necessary.

anamnese

The first step towards diagnosis is a thorough survey of the medical history (anamnesis) in an interview. The doctor will ask you questions such as:

  • How long have you had the rash on your face?
  • Which care products do you use?
  • Do you use makeup?
  • Do you use medicated ointments or creams on your face?

In most cases, the anamnesis already provides the doctor with the first indications as to whether mouth rosy might be present.

Physical examination

In the next step, the doctor examines the rash on the face more closely. Among other things, he pays attention to whether there are blackheads and whether the sebum glands in the skin are blocked (signs of acne) or whether the fine blood vessels in the face are clearly visible (signs of rosacea). If none of this is the case, this speaks for periroral dermatitis – especially if a one to two millimeter wide rim around the mouth is not affected by the changes.

biopsy

In some cases, the removal and analysis of a tissue sample ( biopsy ) from the inflamed area can be useful. The microscopic examination of the sample is carried out in the laboratory. In perioral dermatitis, a spongy tissue (spongiosis) can be seen under the microscope. Lymphocytes , ie white blood cells, are stored in the area of ​​the fine, colorless hair roots (vellus hair follicles) . This is not the case with healthy skin and is another indication of mouth rose.

Perioral dermatitis: treatment

The most pressing question for many people with perioral dermatitis: What helps quickly against the unpleasant rash on the face?

The first step in the treatment is the so-called zero therapy – ie the complete renunciation of all skin cleaning and skin care products as well as cosmetics. This should be maintained for six to twelve weeks, with the first successes usually being seen after three weeks. During zero therapy, those affected should also refrain from:

  • Creams with corticosteroids
  • fluoridated toothpaste
  • perfume
  • perfumed detergents
  • room sprays

Thorough and gentle cleansing of the face is also advisable – without cosmetics or chemicals, just with lukewarm water. The use of microfiber cloths has also proven itself. They gently remove impurities from the skin.

If additional cleansing of the face is necessary, you can use so-called syndets sparingly. These are washing lotions with surfactants. The pH of these agents is very similar to that of the skin. As a result, Syndets put less strain on the skin than conventional cleaning agents. You can get suitable syndets in pharmacies or drug stores.

After cleansing, gently pat (do not rub!) face with a clean towel. The towel should have been washed with a detergent without fabric softeners and fragrances.

Perioral dermatitis: medication

Sticking to strict zero therapy is usually not an easy task for people with perioral dermatitis. Creams, ointments, gels, solutions and, if necessary, oral preparations with certain active ingredients can then help against the symptoms.

  • Sodium bituminosulphate gel : The gel is applied very thinly to the inflamed areas of the skin in the evening. It works against excessive sebum production, reduces inflammation and itching and helps fight bacteria and fungi.
  • Zinc ointment : If the rash around the mouth is persistent, an ointment containing zinc may help.
  • Pimecrolimus cream : The active ingredient suppresses the immune system and can be given to patients with perioral dermatitis for a period of two years.
  • Antibiotics : The doctor often prescribes local preparations such as antibiotic ointments or solutions (such as those containing metronidazole or erythromycin). In more severe cases, taking antibiotic tablets can make sense (eg with doxycycline or minocycline – two representatives from the group of tetracyclines).
  • Isotretinoin : If the mouth is severe and does not respond adequately to antibiotics, treatment with the acne drug isotretinoin may be attempted. Under no circumstances should a woman become pregnant while taking it, because the active ingredient can cause serious harm to the unborn child.

When and which drugs are used – alone or in combination – depends on the individual case. Your doctor will also tell you how to use a preparation correctly and how long you should continue treatment. Antibiotic therapy, for example, is stopped as soon as the rash on the face has disappeared.

Before you use a preparation on the inflamed skin for the first time, you should always test its compatibility on a small area on the back of your hand.

Perioral dermatitis: home remedies

Home remedies can help treat perioral dermatitis, namely moist compresses with black tea: the tannins in black tea have an astringent and drying effect on over-treated skin. The cool moisture of the compress relieves itching and tightness.

To do this, soak a compress in cooled black tea, squeeze out a little and place on the affected area of ​​​​skin. If necessary, cover with a cotton cloth. Leave the compress on for 10 to 15 minutes. Then clean your face with clear water and gently pat dry.

Remove the compress immediately if it feels uncomfortable, causes a burning sensation on the skin, or worsens the symptoms of the condition!

Home remedies have their limits. If the symptoms persist over a longer period of time, do not get better or even get worse, you should always consult a doctor.

Perioral dermatitis: diet

A special diet that helps against perioral dermatitis is not yet known. However , the skin always benefits from a diet that is as natural as possible . That means:

  • Eat a balanced and healthy diet with plenty of fruit, vegetables and fibre.
  • Avoid highly processed foods and artificial additives such as colorings. In the long run, these can weaken the immune system and thus promote skin inflammation, among other things.

You should also avoid stimulants such as alcohol and nicotine . The substances damage the skin’s natural protective shield and make it more susceptible to pathogens.

Covering the skin changes

The reddened and scaly skin with pustules and papules on the face is a cosmetic problem for many of those affected and creates a high level of suffering. The stress caused by this can intensify the clinical picture. Anyone who wants to cover the affected skin areas with cosmetics should consult a doctor or pharmacist about suitable products beforehand. Because ordinary make-up can increase the symptoms.

Perioral dermatitis: course and prognosis

Without treatment, the disease can last for several months. However, if perioral dermatitis has been correctly diagnosed and the patient follows the doctor’s treatment recommendations, the prognosis is good. With the right cleaning and the right care products, the inflammation usually heals within a few weeks. Perioral dermatitis usually leaves no scars.

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