Perioral dermatitis
Definition & Synonyms
- Perioral dermatitis (POD) = chronic-recurrent, rosaceiform dermatosis with follicular papulopustules perioral / perinasal / periocular with a free zone directly around the vermilion border.
- Synonyms: Classic terms are Stewardess disease + Rosacea-like dermatitis + Light-sensitive seborrheid — first described 1957 in stewardesses due to cosmetic exposure.
- Granulomatous perioral dermatitis (GPD) as special form with firmer red-brown papules, more common in children (FACE syndrome).
Epidemiology & Pathogenesis
- Women 20–45 yr dominate (~ 90 %); children affected bilaterally (granulomatous form).
- Triggers: Most common triggers are topical glucocorticoids + fluoride toothpaste + occlusive cosmetics plus hormonal fluctuations (pill/pregnancy).
- Pathogenesis: Probable disturbed epidermal barrier + Demodex overgrowth + follicular damage — hence focal sparing around vermilion (no follicular epithelium at mucocutaneous junction).
- "Steroid rebound": Upon stopping topical GCS, there is paradoxical flare-up reaction due to tachyphylaxis — patients often present after several steroid cycles.
Clinical Presentation
- Location: Typical is perioral with free zone at vermilion + perinasal + periocular — the narrow free zone directly around the vermilion is pathognomonic.
- Morphology: 1–2 mm follicular red papules + papulopustules on erythematous base + fine scaling.
- Symptoms: Burning / tightness > pruritus; women apply more makeup → vicious cycle.
- Special forms: Granulomatous POD (children, periorbital + perinasal), Lupus miliaris disseminatus faciei (adults, granulomatous, scarring healing).
Diagnostics
- Clinical visual diagnosis — no specific laboratory diagnostics.
- History: Obligatory is asking about topical steroids + toothpaste + cosmetics + hormonal status — steroid use is often only admitted upon direct questioning.
Differential diagnoses
- Acne vulgaris
- Rosacea
- Seborrhoeic dermatitis
- Rosacea fulminans / Pyoderma faciale
- Acneiform eruption
- Demodicosis
- Candida intertrigo
Practise Perioral dermatitis in the app
Flashcards with spaced repetition, exam questions and spot-the-diagnosis on this topic – in DermaFuchs, free of charge.
In the DermaFuchs app: 6 flashcards · 5 clinical images
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More diseases of the skin appendages
- Acne fulminans
- Hidradenitis suppurativa (acne inversa)
- Acne vulgaris
- Alopecia areata
- Androgenetic alopecia
- Folliculitis (infectious)
- Lichen planopilaris
- Milia (milium)
Note: This page is intended for medical education and does not replace diagnosis or treatment decisions in individual cases. Treatment and follow-up content is available in the app.