Perioral dermatitis is a common facial rash of small red bumps around the mouth, nose or eyes, most often in young women and children. Topical or inhaled steroids are a frequent trigger, and the rash often flares when the steroid is stopped before it gets better.
Key symptoms
- Small red bumps and pustules around the mouth, nose or eyes
- Mild burning or stinging more than itch
- Worse with heavy creams or cosmetics
- Use of a steroid cream or inhaler on or near the face
What you find on exam
- Clusters of small papules and pustules on red, scaly skin
- Narrow band of clear skin right next to the lip border
- No blackheads or whiteheads, unlike acne
- Check for rosacea signs: flushing and small visible vessels
Tests
- Diagnosis is clinical
- KOH prep or culture if a fungal or bacterial infection is suspected
- Patch testing if a contact allergy is suspected
Treatment basics
- Stop topical steroids (taper if potent) and warn about the rebound flare
- Zero therapy: gentle cleanser, no heavy creams or cosmetics
- Topical metronidazole, azelaic acid or pimecrolimus
- Oral doxycycline for 6 to 8 weeks if moderate; erythromycin in children under 8
Red flags
- Getting worse despite stopping steroids and starting treatment
- Eye pain, redness or vision change
- Large pustules, fever or crusting that suggest infection
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.