From the Guidelines
Peri-oral discoloration is most effectively managed by identifying and treating the underlying cause, with topical treatments such as barrier creams or depigmenting agents being used for mild cases, and medical evaluation being necessary for persistent or worsening conditions. The causes of peri-oral discoloration can vary, including irritation, hyperpigmentation, and fungal infections like peri-oral dermatitis 1. For mild cases caused by irritation, applying a barrier cream like petroleum jelly or zinc oxide ointment to the affected area 2-3 times daily until the discoloration resolves can be effective. If the discoloration appears brownish (hyperpigmentation), considering using a topical depigmenting agent containing hydroquinone 2-4%, kojic acid, or azelaic acid, applied thinly once daily for 8-12 weeks, may be beneficial 1.
For fungal causes like peri-oral dermatitis, using an antifungal cream such as clotrimazole 1% or ketoconazole 2% twice daily for 2-4 weeks can be an appropriate treatment option. However, if the condition persists or worsens, seeking medical evaluation is crucial as prescription treatments may be necessary, including topical metronidazole 0.75% for inflammatory causes or low-potency corticosteroids for certain conditions. It is also important to avoid potential irritants like fluoridated toothpaste, cinnamon flavoring, and harsh facial products. Maintaining good oral hygiene and avoiding lip licking can prevent recurrence.
In some cases, peri-oral discoloration can be associated with systemic conditions, such as those affecting patients with renal failure, who may experience various oral manifestations including lichenoid oral lesions, oral hairy leukoplakia, and uremic stomatitis due to their underlying disease or immunosuppressive therapy 1. Therefore, a comprehensive medical evaluation is essential to determine the underlying cause of peri-oral discoloration and to provide appropriate treatment. The most recent and highest quality study on the management of peri-oral discoloration is not directly available, but based on the provided evidence, a step-wise approach starting with topical treatments and progressing to medical evaluation for persistent cases is recommended 1.
From the Research
Peri-oral Discoloration
- Peri-oral discoloration can be caused by various factors, including pigmented lesions, which can be either normal or abnormal discoloration of oral mucous membrane 2
- The etiology of pigmentation can be multi-factorial, and mostly pigmentation is physiologic, but at times it can be a precursor of severe diseases 2
- Lesions may be caused by localized harmless accumulations of melanin, hemosiderin or exogenous metals or they may be a sign of underlying systemic or genetic disease 2
- Perioral lesions and dermatoses can include seborrheic keratosis, warts, actinic keratoses, actinic cheilitis, and squamous cell carcinoma, among several other perioral cutaneous lesions 3
Treatment Options
- Topical measures are the mainstay treatment for postinflammatory hyperpigmentation (PIH), and numerous studies have assessed the efficacy of topical medications for the treatment of PIH 4
- Topical agents with high-quality studies included retinoids, hydroxy acids, corticosteroids, thiamidol, niacinamide, and plant-derived products, and sunscreens with SPF30 or greater were recommended in almost every study 4
- For melasma, triple combination cream (hydroquinone, tretinoin, and corticosteroid) remains the most effective treatment, as well as hydroquinone alone, and oral tranexamic acid is a promising new treatment for moderate and severe recurrent melasma 5
Diagnosis and Management
- The differential diagnosis for any pigmented lesion is extensive, and includes examples of endogenous and exogenous pigmentations, and biopsy is a helpful and necessary aid in the diagnosis of focally pigmented lesions 2
- Dental professionals are well positioned to evaluate perioral skin conditions, further contributing to patients' general health, and a thorough dental and medical history and laboratory investigations are necessary for diagnosis and management 2, 3