What causes perioral dermatitis?

From the Guidelines

Perioral dermatitis is primarily caused by the overuse of topical corticosteroids on the face, as they may cause perioral dermatitis and skin atrophy if used inadequately 1. The condition can be triggered or worsened by several other factors, including:

• Fluorinated toothpastes
• Heavy facial moisturizers
• Makeup products
• Certain sunscreens
• Hormonal changes
• Oral contraceptives
• Rosacea Environmental factors like UV exposure, heat, and wind can also exacerbate symptoms. The condition typically presents as small red bumps, pustules, and mild scaling around the mouth, nose, and sometimes eyes. Treatment usually involves discontinuing all topical steroids and irritating skincare products, which may temporarily worsen symptoms before improvement occurs. For moderate to severe cases, healthcare providers often prescribe topical antibiotics like metronidazole or clindamycin applied twice daily for 8-12 weeks. Oral antibiotics such as doxycycline or minocycline for 4-8 weeks may be needed for more severe cases. The condition likely develops due to altered skin microbiome and barrier function, with topical steroids suppressing local immune responses and causing rebound inflammation when discontinued 1.

From the Research

Causes of Perioral Dermatitis

• The etiopathogenesis of perioral dermatitis remains unclear, but there are several factors that contribute to its development, including:
  • Prolonged use of topical products, especially corticosteroids, in the treatment of rosacea and seborrheic dermatitis 2, 3, 4
  • Various skin irritants 2
  • Physical and hormonal factors, which all share the epidermal barrier dysfunction as an underlying main pathogenic factor 2
• Topical corticosteroid use is a common preceding factor in the manifestation of perioral dermatitis, but it is unclear whether it is a cause or a contributing factor 3, 4
• Other possible causes include:
  • Cosmetics 5
  • Fusobacteria 4

Risk Factors

• Perioral dermatitis primarily affects women aged 15 to 45 years, but it can also affect children and men 2, 3
• The granulomatous form of perioral dermatitis is more common in childhood and affects mostly prepubescent boys 2

Pathogenesis

• The exact pathogenesis of perioral dermatitis is not fully understood, but it is thought to involve a combination of factors, including:
  • Epidermal barrier dysfunction 2
  • Inflammation 2, 6
  • Bacterial infection, such as fusobacteria 4