It is a more frequent problem in the female population aged between 20 and 40 years and in children and infants; In addition to the area around the mouth, it also affects the skin in other parts of the face: it is perioral dermatitis, a disorder that can be confused with seborrheic dermatitis and contact dermatitis and that in some respects is similar to acne and rosacea.
In winter it can occur in the form of irritative dermatitis and mainly affects children, who may find themselves struggling with an annoying redness around the lips.
Contact with saliva, often used to moisten the cracked area, can lead to a worsening of the situation, establishing a vicious circle that turns the initial redness into a more serious and annoying problem, often not easy to solve.
The remedies, however, are not lacking and, contrary to what happens in the case of other disorders of dermatological competence, it is also possible to suspend treatments.
By following the right advice it is then possible to reduce the risk of the problem recurring, but the danger of recurrence is just around the corner.
Perioral dermatitis: what is it
Perioral dermatitis is a dermatological problem that often takes on a chronic character.
Fortunately, it is not a dangerous disease for health, but the emotional problems triggered by the appearance of the skin of the face can be a source of stress that can worsen the quality of life of those who suffer from it.
What’s more, in some cases, it can lead to the formation of scars.
Its incidence seems to be higher in more developed countries. However, no official statistics are available to certify it.
Symptoms of perioral dermatitis
In the symptomatology of perioral dermatitis, the appearance of a facial erythema characterized by the presence of papules, i.e. small lesions (less than one centimeter) in relief with respect to the skin surface, predominates.
The edges of the lesions are sharp and generally there is no liquid inside them; However, in some cases pustules or papulo-vesicles containing serum or pus may be present.
The disease can be distinguished from acne because it is not associated with the presence of comedones (the so-called “blackheads”), while the difference compared to rosacea is the appearance of eczema around the mouth and eyes.
Generally, erythema appears as a simple reddening between the upper lip and the nose, or at the level of the chin, which initially spreads in the area around the mouth (without however involving the skin around the vermilion, the red part of the lip), and then extends to the region around the eyes and also affects the forehead; The most affected areas, however, remain the labial filter (the groove between the nose and the upper lip), the chin and the skin around the mouth up to the nasogenieni furrows (the folds that join the sides of the nostrils to the corners of the mouth).
Dryness is intense and associated with peeling, and tends to become a chronic problem. Laughing, or even just talking, can cause discomfort, and there are cases in which dehydrated and flaky areas become infected. In fact, the skin loses its barrier function and becomes more sensitive to aggressive external agents, such as low temperatures, wind, bacteria and fungi.
Infections can lead to the leakage of a serum that tends to crystallize and the formation of yellowish crusts; The problem can end up degenerating into impetigo, a skin infection that is particularly common among children.
As in the case of atopic dermatitis, also in that of perioral dermatitis dryness is often associated with itching, which can even precede the appearance of erythema and be persistent.
The clinical picture can be completed with a burning of varying intensity that tends to accentuate when it is particularly cold and if the climate is dry.
The diagnosis is essentially based on the analysis of the characteristics of erythema, but it is always good to exclude other frequent problems in dermatology: seborrheic dermatitis and contact dermatitis due to allergies (DAC, allergic contact dermatitis).
Causes of perioral dermatitis
The true causes of perioral dermatitis have not yet been fully elucidated. It has been hypothesized, for example, that the problem may originate or be promoted by chronic irritative or allergic dermatitis.
Among the factors that can cause it is the use of certain substances present in cosmetics or other oral hygiene products, such as surfactants contained in detergents and toothpastes, emollients, petroleum jelly and paraffin, as well as fluoride (another possible ingredient of toothpaste that exerts an irritating action).
Exposure to corticosteroids in products to be applied topically could also be the trigger for some cases of perioral dermatitis.
However, substances that come into contact with the skin are not the only possible culprits of eczema. It has been hypothesized that the onset of perioral dermatitis may be linked to intestinal problems (for example malabsorption), alterations in the levels of sex hormones (so much so that in women skin symptoms may be associated with alterations of the menstrual cycle) and the action of microorganisms, in particular Bacillus fusiformis, Helicobacter pylori, Candida albicans and the mite Dermodex folliculorum (also associated with rosacea).
Finally, there is no shortage of causes of psychological origin: in particular, perioral dermatitis can be associated with anxiety or depression.
Remedies for perioral dermatitis
Unfortunately, treating perioral dermatitis can be difficult and the path to solving the problem can take months. In addition, cases of recurrence are frequent.
Natural remedies such as cold compresses of a chamomile infusion can help fight redness and irritation, but often to solve the situation it is essential to suspend any ongoing treatment (for example the use of topical cortisone-based products) and avoid cosmetics and products containing fluoride, including toothpastes.
An antibiotic or antifungal may be prescribed to be applied twice a day topically, usually in the form of a cream or gel.
Immunosuppressants and barrier creams based on zinc oxide can also be used. The latter, however, could aggravate dryness, worsening the condition in which the skin is located.
In the event that the use of topical products does not give the desired results, it is possible to take antibiotics or oral antifungals.
Treatment with antibiotics to be taken orally can last for 4 weeks, followed by a period in which the dosage is minimized. It is usually possible to arrive at a suspension of treatment.
In case of granulomatous perioral dermatitis, treatment with a form of retinoic acid also used to treat mild-moderate cases of cystic acne may also be effective.
Before using these products it is good to consult your doctor, especially if you are pregnant or breastfeeding: some active ingredients may be contraindicated.
Finally, in the event that the association with hormonal imbalances is clear, it is good to act on the latter.
Once the erythema has disappeared, it is possible to take care of the skin by rehydrating it and trying to restore its functionality with emollient and restorative treatments.
Among the useful ingredients in this sense are included for example vitamin E, shea butter and white beeswax.
How to prevent perioral dermatitis
When the skin begins to irritate it is good to protect it from the risk of infection; It is better not to touch it with dirty hands and avoid it coming into contact with nasal secretions, especially when these increase due to diseases such as colds.
Other useful measures for the prevention of this disease are to avoid direct exposure to sunlight, wind and low temperatures and the use of fluoride toothpastes.
Nutrition can also play its part somewhat. It is advisable to avoid contact with very hot or very cold foods.
It is also good to ensure a healthy diet that helps keep the inflammatory response under control.
Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.
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