Oral Dermatitis vs. Facial Eczema: Understanding the Differences
Oral dermatitis is not the same as eczema on the face, although they share some similarities. The terms 'eczema' and 'dermatitis' are often used synonymously to describe a polymorphic pattern of inflammation, but specific types have distinct characteristics, triggers, and treatment approaches. 1
Definitions and Classification
Eczema (or dermatitis) is characterized by a polymorphic pattern of inflammation that in the acute phase shows erythema and vesiculation, and in the chronic phase presents with dryness, lichenification, and fissuring 1
Contact dermatitis specifically describes reactions in response to external agents, which may act as either irritants (not involving T cell-mediated immune response) or allergens (involving cell-mediated immunity) 1
Oral/perioral dermatitis is a specific acneiform facial eruption that commonly occurs around the mouth and can be triggered by topical corticosteroid use 2
Types of Dermatitis Affecting the Face
Contact Dermatitis (can affect facial area)
Subjective irritancy: Idiosyncratic stinging reactions occurring within minutes of contact, usually on the face, without visible changes - often triggered by cosmetics or sunscreens 1
Irritant contact dermatitis: Can be acute (from single strong exposure) or chronic/cumulative (from repeated exposure to weaker irritants) 1
Allergic contact dermatitis: Involves immune sensitization to specific allergens resulting in dermatitis 1
Perioral/Oral Dermatitis
Characterized by acneiform eruptions specifically around the mouth and other facial orifices 2
Often preceded by topical corticosteroid use on the face 2
Has variants including periorificial and granulomatous periorificial dermatitis 2
Facial Eczema/Atopic Dermatitis
Part of a chronic inflammatory skin condition affecting various body parts 3
Characterized by intense itching and recurrent eczematous lesions 3
Often associated with atopy and other allergic conditions 3
Key Differences
Location and pattern: Oral dermatitis specifically affects the area around the mouth and sometimes other facial orifices, while facial eczema can affect any part of the face 2
Appearance: Oral dermatitis typically presents as small papules and pustules on an erythematous base around the mouth, while facial eczema presents with the classic eczematous features of erythema, scaling, and potentially vesiculation 2, 1
Triggers: Oral dermatitis is frequently associated with topical corticosteroid use, whereas facial eczema is often related to atopic predisposition, allergen exposure, or irritant exposure 2, 3
Diagnostic Considerations
Clinical features alone are unreliable in distinguishing between different types of facial dermatitis 1
Patch testing is essential for patients with persistent eczematous eruptions when contact allergy is suspected 1
The pattern and morphology of dermatitis, particularly on the hands and face, is unreliable in predicting cause and distinguishing between atopic/endogenous dermatitis and contact irritant or allergic dermatitis 1
Treatment Approaches
For Oral/Perioral Dermatitis:
Discontinuation of topical corticosteroids (if being used) 2
Topical treatments: metronidazole, erythromycin, or pimecrolimus 2
Oral tetracyclines for adults and children over 8 years of age 2
For Facial Eczema/Atopic Dermatitis:
Restoration of epidermal barrier function through emollients 3
Topical corticosteroids for acute flares 3
Topical calcineurin inhibitors for maintenance therapy 3
Proactive therapy with twice-weekly application of topical treatments in previously affected areas to reduce recurrence 4
Common Pitfalls and Caveats
Misdiagnosis between different types of facial dermatitis is common due to similar clinical presentations 1
Using topical corticosteroids for oral dermatitis can initially improve symptoms but may lead to rebound worsening when stopped 2
Failure to identify and avoid triggers (especially in allergic contact dermatitis) can lead to persistent symptoms 1
Overlooking the possibility of secondary bacterial infection, particularly with Staphylococcus aureus, which may require specific treatment 4