Perioral dermatitis is a chronic dermatological disease characterized by lesions of the skin around the mouth with the appearance of grouped or single papules on a hyperemic or ordinary epidermis.
Translated from Latin, the term literally means "around the mouth." For a long time, the disease was attributed to seborrhea, and was called photosensitive seboride. Other terms referring to this pathology are rosacea-like dermatitis, steroid-induced dermatitis, photosensitive dermatitis.
The main instigator of the disease is the change in the levels of sex steroid hormones. More often pathology develops in women of childbearing age (from 20 to 35 years). In men, cases of oral dermatitis are recorded less frequently - in just 1 of 12 situations. Most often this is due to the active phase of puberty.
Sometimes the disease occurs in older men, as well as in babies.
Causes of development
The exact reasons for the development of perioral dermatitis are not completely clear. However, there are several factors that, according to numerous observations, that can cause this disease. These include:
- Abuse of hormonal (steroid) ointments - Hydrocortisone, Prednisone, etc.
- The use of low-quality cosmetic products for skin care of the face. First of all, it concerns the tonal creams.
- Frequent use of toothpastes containing fluoride.
- UV radiation, strong wind exposure.
- Acceptance of oral contraceptives is rare, but, nevertheless, can cause the progression of the disease.
- Changes in hormonal levels (during the period of PMS, menstruation, pregnancy, or for any other reasons).
- The reproduction of fungi and bacteria in the hair follicles around the mouth.
It is proved that the development of perioral dermatitis occurs more often in people who use several facial cosmetics at once. The simultaneous use of nutritional, daytime moisturizing and foundation creams is one of the most common causes of this pathology. But applying only a moisturizer does not harm the health of the skin.
In recent years, perioral dermatitis is increasingly developing in men, which is explained by the use of various facial care products.
Symptoms of perioral dermatitis
Perioral dermatitis (see photo) looks like single or grouped papules having a spherical shape. They have a red or red-pink color, and are localized around the mouth on the hyperemic or unchanged skin. A rash can cause itching, a feeling of tightness of the skin, a burning sensation. However, in 25% of situations, patients do not show any complaints.
Due to the large number of papules, the skin feels rough to the touch. The rash may be expressed, and in their place crusts form. If you start to peel them, you can provoke the appearance of hyperpigmentation.
The most common rash in perioral dermatitis affects the skin:
- nasolabial triangle;
- nasolabial folds;
- corners of the mouth.
Less commonly, periorbital dermatitis is diagnosed, in which the rash is localized to:
- epidermis of the corners of the eyes;
- lower and upper eyelids;
- nose bridge.
In approximately 50% of cases, patients suffer from mixed forms of perioral dermatitis. In such situations, the rash affects not only the skin around the mouth, but also other areas of the face. In many patients, the epidermis in the area of the red border remains normal, and forms a rim of a pale tinge about 4 mm wide.
Features of the disease in children
The course of perioral dermatitis in children younger than adolescence occurs predominantly in the granulomatous form. This feature of the disease differs in the nature and location of the rash.
Granulomatous eruptions in perioral dermatitis in children have either a solid or pinkish hue. Sometimes they get a tan color. As a rule, no other symptoms of children with this form of the disease do not alarm. Occasionally, there may be complaints of a burning sensation in the area of the location of the pathological rash.
The rash can be represented by single or grouped elements. It can affect not only the skin in the mouth, but also the epidermis around the eyes, in the auricle area, on the head, in the outer part of the genitalia, and also on the surface of the skin of the hands and feet.
One of the most important diagnostic criteria for suspected perioral dermatitis is the presence of a white strip on the skin around the lips. At the same time, even if the most severe form of the pathological process occurs, the patient will necessarily have an untouched zone.
Diagnosis of perioral dermatitis includes a whole range of research procedures. Among the laboratory tests, first of all, conduct:
- biochemical research to determine the level of immunoglobulins in the patient's blood;
- general clinical blood test;
- blood and urine tests to measure hormone levels.
Among the instrumental methods of diagnosis in the first place endure:
- ultrasound examination of the pelvic organs;
- magnetic resonance imaging of the adrenal glands and the region of the Turkish saddle. This diagnostic measure is necessary to assess the functioning of the pituitary gland, responsible for the production and release of most hormones, especially steroid, sex.
Note. If we talk about what is perioral dermatitis, this disease implies a violation of the skeleton of the dermis, as a result of which structural morphological changes occur in the epidermis - the surface layer of the skin.
Perioral dermatitis is extremely important to differentiate from:
- seborrheic dermatitis;
- cutaneous tuberculosis;
- atopic and contact dermatitis;
- manifestations of systemic lupus erythematosus;
It is very important to distinguish the granulomatous form of perioral dermatitis from sarcoidosis, which is characterized by the formation of granulomas in the dermis. To obtain the most accurate data, a histological examination of tissues taken from the surface of the skin affected by rashes is carried out.
Possible complications and consequences
Perioral dermatitis occurs in a chronic form. The periods of remission are replaced by relapses, and during this time the patient may notice the appearance of intense lesions on the skin and a general deterioration of health.
If you do not start therapy in time, this will lead to the appearance of pigment spots and scars on the skin surface. The occurrence of cosmetic defects can cause psychological problems in the form of complexes, neurosis, and even depression.
Treatment of perioral dermatitis takes time, and sometimes it may not give the expected results the first time. Often, after it is possible to almost completely get rid of inflammation, new ones appear on the site of old eruptions.
First of all, you need to cancel the ointment on the basis of GCS, if used by the patient. It should be borne in mind that such a step may provoke the development of the so-called "withdrawal dermatitis", in which there is a worsening of the general symptoms of the disease.
For a complete cure of pathology, it is important to approach the issue of therapy in a complex. This means that treatments should be accompanied by comorbidities and a rash on the face caused by dermatitis. Dieting is a must.
Treatment for perioral dermatitis can be performed using:
- Antiseptics. These drugs kill the pathogenic microflora and prevent its re-development in the inflamed areas of the skin. Chlorhexidine, Miramistin, Sulsen have good efficacy.
- Antiprotozoal drugs. The preparations based on metronidazole are well struggling with manifestations of perioral dermatitis. So, in the initial phase of the development of the disease Metrogil gel can be used. In the absence of the expected results, Trichopol tablets are prescribed. Metronidazole ointment is also a good alternative.
- Antibiotics. They are necessary when joining a secondary infection. Often prescribed systemic antimicrobial agents Doxycycline, Azithromycin, Erythromycin, etc. You can use the gel for external use of Skinneron.
- Regenerative medicines. They speed up the healing process of wounds and ulcers formed on the site of papules. Ointments Sintomitsin, Bepanten, Methyluracil, etc., have proven themselves well.
- Anti-inflammatory external agents - zinc ointment, Skin Kapa, Zindola. You can also use sulfur ointment, or Elidel.
- Antihistamines for external use. In this case, the choice should be stopped on non-hormonal drugs, since hormonal gels and creams can significantly aggravate the situation. You can also use systemic antihistamines - Suprastin, Nixar, Tavegil, Fenkarol, etc.
- Vitamin complexes - AlfaVita, Aevita, Supradina.
In case of complicated disease, oral NSAIDs may be prescribed. For example, Nurofen or Ibunorm helps to eliminate pain.
Good results in the fight against perioral dermatitis are given by homeopathic remedies - Apis, Kantaris, Grafitses. However, the possibility of their use must necessarily be negotiated with the attending physician individually.
In order to avoid relapses, you should use only high-quality cosmetics for the face. Do not use products that dry out the skin. Soft and moisturizing effect on the epidermis has, for example, lotion Setafil.
Physiotherapy also helps to get rid of the manifestations of perioral dermatitis. Excellent results are shown by:
- Ice massage sessions. To this end, the affected skin is treated with ice cubes. This procedure accelerates the regeneration processes in the epidermis.
- UFO. Dosed ultraviolet irradiation contributes to the speedy recovery of the affected epidermis.
- Laser therapy. Such a therapeutic approach involves exposure to the skin of weak laser beams. This procedure has anti-inflammatory properties.
- Electrophoresis. In this case, the necessary doses of drugs are given using a constant electric current.
Physical therapy has a complex effect: anti-inflammatory, regenerating, restorative. But to conduct such sessions can not be in the presence of pustular eruptions on the skin.
Mild perioral dermatitis is successfully treated with herbal lotions and compresses. The following recipes are effective:
- lotion on the basis of broth celandine well help eliminate rashes on the face;
- St. John's wort is used for warm compresses and lotions, as it has anti-inflammatory properties;
- applications based on oak bark decoction;
- decoction of birch buds is intended for oral administration. It is taken in the amount of 0.5 cups once a day, and is also used to wipe the affected skin.
Yarrow herb copes well with a rash that spreads over the face. A glass of ready-made decoction should be mixed with 6 ml of apple cider vinegar and 50 ml of medical alcohol. The finished medicine is used as a lotion to wipe the epidermis.
Another good remedy is sage decoction. In the form of heat it is used for steam baths for the face, in the cold - as a means for lotions.
A person with perioral dermatitis needs not only to undergo a course prescribed by the doctor. For complete recovery and prevention of pathology in the future, it is important to follow certain rules regarding nutrition.
Thus, the categorical "no", first of all, you must say:
- different types of fish;
- canned food;
- alcoholic beverages;
- strong tea;
- citrus fruits;
- foods that contain large amounts of carbohydrates.
Instead, preference should be given to:
- whole grain bread;
- fermented milk products;
- green vegetables, fruits;
- lean meats
The main menu of a patient with a diagnosis of "perioral dermatitis" should primarily consist of cereals from different types of cereals, light soups, dairy products, boiled or steamed vegetables / fruits. Moderate consumption of pasta, cheese, dried bread, berry compotes and jelly is allowed. It is allowed to include in the menu fruits and vegetables that are not classified as allergens (apples, pears, bananas), as well as lean poultry or fish meat in baked, boiled, or steamed.
Also do not forget about the drinking regime. An adult per day is recommended to use from 1.5 to 2 liters of fluid.
To prevent the development of perioral dermatitis - primary or repeated - it is necessary to abandon the uncontrolled use of hormonal ointments, creams and gels for the treatment of the skin of the face. It is necessary to treat the inflamed areas of the epidermis only with drugs that do not contain corticosteroids. This applies to any dermatological diseases, including perioral dermatitis.
If the treatment was started in a timely manner, and experienced doctors of different profiles took part in its appointment, then the prognosis for a full recovery and a reduction in the risk of recurrence of the pathological process will be most favorable. In self-treatment, the likelihood of a new outbreak of the disease will remain extremely high.