Download Perioral dermatitis mostly targets women

Perioral dermatitis
mostly targets women
This inflammatory skin disorder may have a hormonal cause and can often
be linked to topical steroids, writes Johnny Loughnane
Forum
Dermatology
Perioral dermatitis – note spread to lower eyelid
Perioral dermatitis following use of clobetasone .
Note more inflammatory rash when steroids have
been used
PERIORAL DERMATITIS is an inflammatory skin disorder, particularly common in women between the ages of 20 and 40.
The cause is not known, although the female predominance
may point to hormonal factors. Many patients have used topical steroids.
It presents with papules, scaly erythema and, rarely, pustules. The absence of open and closed comedones helps
distinguish it from acne. The rash is distributed around the
mouth with sparing of the skin immediately adjacent to the
lips. The nasolabial fold and lower eyelid are often involved.
Rarely, the upper eyelids are involved.
If topical steroids have been applied, the rash becomes
more florid, with the papules a deeper red and scaly erythema more prominent. Keep in mind that it may present
with periocular involvement alone. It is rare in males and
one should always suspect steroid use, which must be
enquired into. Often the steroid has been applied to an area
of seborrhoeic dermatitis. While potent and very potent
steroids are the usual culprits, it can also occur with moderately potent steroids.
A feeling of slight itch or stinging is usual and some
patients complain of a tight feeling in the areas involved. If
steroids have been applied, this feeling of tightness may
worsen for a while following steroid withdrawal. It is important to warn patients about this. Topical steroids tend to
relieve this feeling, so the patient may be tempted to reuse
them. Advise patients to use a moisturiser instead.
If there is an unacceptable flare on stopping a potent
steroid, one may wean the patient off steroids – first using
Perioral dermatitis with sparing of skin
immediately adjacent to lips
clobetasone (Eumovate) for five days before replacing it with
hydrocortisone for a further five days. All steroids must then
be stopped.
When the perioral dermatitis is cleared it may be evident
that the patient had seborrhoeic dermatitis. They usually do
well on hydrocortisone – antifungal combination cream, eg.
Daktacort. Hydrocortisone does not seem to cause or exacerbate perioral dermatitis.
Treatment with oral tetracycline is very effective. Usually,
a four week course is all that is needed. If steroids have
been applied, response is slower and an eight week course
may be needed.
Oxytetracycline 250mg-500mg twice daily is the standard
tetracycline. Lymecycline (Tetralysal) 300mg once daily,
may be a better option as its absorption is not so much
reduced by food and once daily dosage may be more convenient.
While treatment is almost always effective, there is a risk
of recurrence. If there is frequent recurrence, one tablet of
lymecycline taken once weekly should be considered.
Many patients will be taking the combined oral contraceptive. Evidence suggests that adding tetracyclines does
not reduce the contraceptive effect. However, standard
advice remains that patients should take extra contraceptive
precautions for the first two weeks of tetracycline use.
Tetracycline is contraindicated in children under 12 and
in pregnancy–here topical erythromycin is an option.
Johnny Loughnane is in practice in Co Limerick
FORUM May 2005 57