Perioral dermatitis 

Perioral dermatitis is a chronic, inflammatory skin condition that manifests as redness, pimples, and scaling around the mouth and nose. It more commonly affects young women, but can also occur in children and men. It is often triggered or maintained by the use of topical corticosteroids and harsh cosmetics.
Causes and triggering factors
The exact cause is not fully known, but the main triggering factors are:
- Prolonged use of topical corticosteroids (even weak ones)
- Cosmetics with irritating ingredients (fluoride, parabens, alcohol, etc.)
- Hormonal changes
- Use of fluoride toothpaste
- UV radiation, wind, heat
- Inhaled corticosteroids
- Microbiome disorders (Demodex, Candida – in some cases)
Clinical picture
- Small erythematous papules and pustules
- Often around the mouth, sometimes around the nose
- Reserved area just around the red border of the lips
- Dryness, tightness, burning or mild itching
- No comedones (a distinctive feature of acne)
Diagnosis
- Placed clinically by a dermatologist based on the distribution and type of lesions
- Dermatoscopy – diffuse erythema, follicular papules
- Differential diagnosis: acne, rosacea, seborrheic dermatitis, contact dermatitis, perioral lupus

Treatment
**1. Stopping topical corticosteroids:**
- May lead to temporary exacerbation ("rebound" phenomenon), which requires patience and maintenance therapy

**2. Local therapy:**
- Metronidazole cream or gel
- Azelaic acid
- Pimecrolimus or tacrolimus – as an alternative to corticosteroids

**3. Systemic therapy (in more severe cases):**
- Doxycycline 40–100 mg daily (usually for 6–8 weeks)
- Minocycline or erythromycin – alternatives in case of intolerance
Skin care
- Avoiding corticosteroid creams unless prescribed by a dermatologist
- Use of gentle cleaning products (no soap, fragrances, alcohol)
- Use of non-comedogenic, hypoallergenic cosmetics
- Changing toothpaste to non-fluoride if a trigger is suspected
Forecast
Perioral dermatitis has a benign course, but often runs a chronic course with relapses. With adherence to therapy and a hygiene regimen, significant improvement usually occurs within a few weeks.

Perioral dermatitis is a treatable condition, but it requires patience, careful care, and avoidance of triggers. With the right approach and follow-up, symptoms can be successfully managed.