Peri-orificial Dermatitis
Overview
Multiple, small, red, inflammatory spots around holes (peri = around, orifice = hole)
Includes the mouth (perioral), nose (perinasal), eyes (periorbital) and genitals (genital POD)
It classically resembles a rash that is somewhere between acne, rosacea and dermatitis.
The cause is not well understood.
Most common in lighter-skinned women aged 20 to 45 years, also seen in young children.
Fact Sheet:
Reference:
Risk Factors
Corticosteroid use via all routes (topical cream, inhalers for asthma, nasal for hayfever)
Cosmetic use
Skin dysfunction due to
Nutritional deficiencies e.g. zinc deficiency
Occlusive emollients leading to overhydration e.g. paraffin or petroleum-based emollients
Sunscreen, particularly in children
Allergic / irritants e.g. toothpaste, dental fillings
Infections
Demodex mites in hair follicles
Fungal infections like Candida
Fusiform Bacteria
Hormonal changes caused by oral contraception, pregnancy, premenstrual
History of atopy (allergies, asthma, hayfever)
Physical factors seem to worsen symptoms
UV light
Heat
Wind
Symptoms
Acne type eruption
Clusters of skin-coloured or red bumps, vesicles or pustules
Can coalesce together
Scaly and flaky skin
Burning or sensation or skin tightness
Itch
Usually only around one orifice (mouth, eyes, nostrils)
Can spread to the chin, cheek, outside eyelids, and forehead
Skin immediately surrounding lips often spared
Management
Stop any topical corticosteroids
For example - Hydrocortisone, Celestone, Disprosone, Advantan
These classically trigger POD and often provide short-term improvement followed by a rebound worsening effect once ceased.
Strong doses can be weaned down over days to weeks
Medically necessary nasal, inhaled or oral corticosteroids should be continued but may delay recovery.
Rinsing the mouth and face after use can help
Avoid any topical products that promote or exacerbate POD
Referred to as “Zero therapy”
Typically involves gentle skin cleansing with a fragrant-free, non-soap cleanser promptly followed by complete and gentle rinsing of the skin
Limiting the use of everything else if possible
Cosmetics
Sunscreens
If needed, a gel or liquid sunscreen can be used
Moisturisers
Occasional “only as needed” application of a bland, non-occlusive moisturiser
Perfume
Once the rash resolves, slowly reintroduce products (e.g. one product per week) and monitor response. Cease any product that induces recurrence.
Mild Disease (relatively small area, no significant emotional distress)
Zero Therapy
Topical Therapy twice daily for 4 to 8 weeks if needed
Elidel (Pimecrolimus) 1% cream
Metronidazole 0.75% or 1% lotion, gel or cream
Erythromycin 1% or 2% gel
May not be tolerated due to facial sensitivity
Moderate Disease (larger areas, emotional distress, failed topical therapy)
Oral Antibiotics
Doxycycline 50 to 100mg twice daily or 100mg once daily
Erythromycin 500mg twice daily
Generally treated for 4 to 8 weeks
Can be effective in small bursts of 1 to 2 weeks