Perioral dermatitis

Lisa Vogel studied departmental journalism with a focus on medicine and biosciences at Ansbach University and deepened her journalistic knowledge in the master's degree in multimedia information and communication. This was followed by a traineeship in the editorial team. Since September 2020 she has been writing as a freelance journalist for

More posts by Lisa Vogel All content is checked by medical journalists.

Perioral dermatitis (rose in the mouth, stewardess disease) is a red, inflammatory rash on the face, the exact cause of which is still unknown. The rash is reminiscent of acne or rosacea and usually shows up around the mouth and chin. Less often, perioral dermatitis affects the eyes or other parts of the face. Here you can find out more about the inflammatory rash, possible triggers of the rose in the mouth and the treatment!

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. L71

Brief overview

What is perioral dermatitis? A chronic inflammatory skin disease of the face that is neither dangerous nor contagious.
Symptoms: red, often itchy rash around the mouth and chin - first with pimples around the mouth, then papules, pustules, plaques; Other areas of the face are less often affected (such as forehead, around the eyes), and in severe cases rash all over the face and on the sides of the neck
Cause: so far unknown; Relationship between over-cared for skin and perioral dermatitis likely; Possible influencing factors: e.g. preparations containing cortisone (such as ointments), stress, gastrointestinal disorders, hormonal contraceptives, etc.
Treatment: Avoiding care and cleaning products as well as cosmetics on the face as well as perfume and perfumed detergents, if necessary medication (with active ingredients such as zinc, antibiotics, isotretinoin), household remedies (compresses with black tea), renouncing stimulants (such as alcohol, nicotine) for several weeks ), healthy, natural nutrition

Perioral dermatitis: definition

Perioral dermatitis (stewardess disease) is a rash that is mostly limited to the skin of the face around the mouth or chin. Because of the visual similarity to shingles, doctors often also speak of oral disease. The red, inflammatory skin changes also resemble acne or rosacea. This is why the skin disease is also known as rosacea-like dermatitis.

The perioral rash on the face is usually chronic - either continuously or in flares (symptoms are milder in the phases between flares).

The skin disease occurs mainly in younger women, usually between the ages of 20 and 45. Children are also more often affected. It is less common for men to develop dermatitis on the face.

Perioral dermatitis is safe and not contagious. It is primarily a cosmetic problem. In addition, the rash on the face can be a psychological burden for those affected.

Perioral dermatitis: symptoms

Perioral dermatitis mainly affects the skin around the mouth and chin, whereby typically a one to two millimeter wide margin adjacent to the red lip is spared from the skin changes. The fine, colorless vellus hairs, the follicles of which are affected in perioral dermatitis, are missing here.

The first sign of the disease is a noticeable number of pimples around the mouth. In the further course the following symptoms may appear:

itchy or burning reddening of the skin (erythema)
0.2 to 0.4 cm large red nodules (papules), some with a yellow tip
flaky skin around the mouth
Pustules around the mouth

Several pustules can merge into so-called plaques. The skin changes are blurred to the side of the face and run out with papules and flaky skin. Some patients also report a feeling of tension in the skin.

Where does the rash occur?

The rash usually forms around the mouth and chin - often starting at the nasolabial folds (folds between the nostrils and corners of the mouth). However, the inflammatory skin changes can also develop on the forehead or, in severe cases, spread to the entire face and the side of the neck.

Very rarely, the skin condition affects the eyelids or just the area around the eyes. Then one speaks of periorbital dermatitis.

In children much more often than in adults, the rash also forms around the nose (perinasal) and / or around the eyes (periocular).

Differentiation from acne and rosacea

In contrast to acne, with perioral dermatitis neither blackheads nor skin size (comedones) develop.

Distinguishing between oral rose and rosacea is more difficult. However, rosacea does not cause a rash on the eye or around the mouth. In addition, this widespread skin disease is accompanied by other symptoms such as visible dilatation of the smallest blood vessels near the skin surface (telangiectasia) and sudden, patchy reddening of the skin (initially fleeting, later persistent).

Perioral dermatitis: causes

The exact cause of the rash around the mouth is not yet known. However, various factors that could be involved in the development of perioral dermatitis are discussed:

Over-cared for skin

In many cases, there is a link between excessive skin care and the occurrence of perioral dermatitis. The frequent use of care products (moisturizing cream, night cream, nutritional cream, etc.) and cosmetics seems to favor the outbreak of oral rose - the skin is over-cared for and over-moisturized, which disrupts its barrier function. As a result, it dries out, is irritated and irritated, which changes the natural skin flora and thus leads to the characteristic inflammatory skin changes.

The use of products containing cortisone on the face can apparently also promote perioral dermatitis. In addition to cortisone ointments, for example, this also includes cortisone preparations for inhalation, such as those used in asthma therapy.

Other influencing factors

In addition, other factors are discussed as possible triggers of the rash on the face, including for example:

sunlight
hormonal contraceptives (anti-ovulatory medicines like the pill)
Gastrointestinal disorders (such as constipation)
increased sebum production in the skin (seborrheic constitution)
fluoridated toothpaste
Colonization of the skin with certain fungi (Candida) or bacteria (such as fusiform spirilla)

Psychological stress can also promote the rash: Stress weakens the immune system and makes the entire body more susceptible to diseases and germs. Perioral dermatitis can also be triggered by stress.

Causes in Children

The chronic rash around the mouth also often affects children - girls more often than boys. As in adults, the exact cause of the disease is still the subject of research.

For example, an American study on the causes of cancers of the mouth in children showed that affected children often also suffer from other skin diseases: 29.3 percent of the children affected in the study also had neurodermatitis and 14.9 percent also had allergic asthma. Almost every tenth child with perioral dermatitis suffered from an allergy. Particularly noticeable: More than half of the children affected by perioral dermatitis (58.1 percent) had previously used cortisone preparations externally.

In addition, experts suspect that - as in adults - excessive skin care can contribute to the development of perioral dermatitis in children.

In smaller children, physical sunscreens with a high sun protection factor are also considered possible triggers: The mineral UV filters on the skin could promote the development of the mouth rose due to their "closing" (occluding) effect.

Perioral dermatitis: examinations and diagnosis

If you notice a change in your skin on your face, your family doctor is the first point of contact. He can assess the symptoms and, if necessary, refer you to a dermatologist.

anamnese

The first step towards diagnosis is a thorough examination of the medical history (anamnesis) during an interview. The doctor will ask you questions such as:

How long have you had the rash on your face?
Which care products do you use?
Do you use makeup?
Do you use medicated ointments or creams on your face?

Usually the anamnesis already gives the doctor the first clues as to whether a rose in the mouth could be present.

Physical examination

In the next step, the doctor examines the rash on the face more closely. Among other things, he pays attention to whether there are blackheads and whether the sebum glands in the skin are clogged (signs of acne) or whether the fine blood vessels in the face are clearly visible (signs of rosacea). If none of this is the case, this speaks for periroral dermatitis - especially if a one to two millimeter wide rim around the mouth is not affected by the changes.

biopsy

In some cases, taking and analyzing a tissue sample (biopsy) from the inflamed area can be useful. The microscopic examination of the sample takes place in the laboratory. In the case of perioral dermatitis, a spongy tissue (spongiosis) can be seen under the microscope. Lymphocytes, i.e. white blood cells, are stored in the area of the fine, colorless hair roots (vellus hair follicles). This is not the case with healthy skin and is another indication of rose in the mouth.

Perioral dermatitis: treatment

The most pressing question for many people with perioral dermatitis: what can help quickly against the unpleasant rash on the face?

The first step in the treatment is the so-called zero therapy - i.e. the complete renunciation of all skin cleansing and skin care products as well as cosmetics. This should be maintained for six to twelve weeks, with the first successes usually already showing after three weeks. During zero therapy, those affected should also avoid:

Creams with corticosteroids
fluoride toothpaste
Perfume
perfumed detergents
Room sprays

In addition, thorough and gentle cleaning of the face is advisable - without cosmetics or chemicals, only with lukewarm water. The use of microfiber cloths has also proven itself. They gently remove impurities from the skin.

If additional facial cleansing is necessary, you can use so-called syndets sparingly. These are washing lotions with surfactants. The pH of these agents is very similar to that of the skin. As a result, syndets are less stressful to the skin than conventional cleaning agents. You can get suitable syndets at the pharmacy or drugstore.

After cleansing, dab the face gently with a clean towel (do not rub!). The towel should have been washed with a detergent that does not contain fabric softeners or fragrances.

Perioral dermatitis: medication

Adhering to strict zero therapy is usually not an easy task for people with perioral dermatitis. Creams, ointments, gels, solutions and, if necessary, oral preparations with certain active ingredients can help against the symptoms.

Sodium bituminosulphate gel: The gel is applied very thinly to the inflamed areas of the skin in the evening. It works against excessive sebum production, soothes inflammation and itching, and helps against bacteria and fungi.
Zinc ointment: If the rash around the mouth is persistent, an ointment containing zinc can help.
Pimecrolimus cream: The active ingredient suppresses the immune system and can be given over a period of two years in patients with perioral dermatitis.
Antibiotics: The doctor often prescribes local preparations such as antibiotic ointments or solutions (e.g. with metronidazole or erythromycin). In more severe cases, taking antibiotic tablets can be useful (for example with doxycycline or minocycline - two representatives from the group of tetracyclines).
Isotretinoin: In the case of severe rose in the mouth that does not respond adequately to antibiotics, treatment with the acne drug isotretinoin may be attempted. A woman must never become pregnant while taking it, because the active ingredient can cause serious harm to the unborn child.

When and which drugs are used - alone or in combination - depends on the individual case. Your doctor will also explain how to use a product correctly and how long to continue treatment. Antibiotic therapy, for example, is stopped as soon as the rash on the face disappears.

Before you use a preparation on the inflamed skin for the first time, you should always first test its tolerance on a small area on the back of the hand.

Perioral dermatitis: home remedies

In the treatment of perioral dermatitis, home remedies can help, namely moist compresses with black tea: The tannins in black tea have a contracting and drying effect on over-cared for skin. The cool moisture of the compress relieves itching and a feeling of tightness.

To do this, soak a compress in cooled black tea, squeeze it out and apply it to the affected area of the skin. If necessary, cover with a cotton cloth. Leave the compress on for ten to 15 minutes. Then clean the face with clear water and gently pat dry.

Remove the compress immediately if it feels uncomfortable, causes a burning sensation on the skin or worsens the symptoms of the disease!

Perioral dermatitis: diet

A special diet that helps against perioral dermatitis is not yet known. However, the skin always benefits from a diet that is as natural as possible. That means:

Eat a balanced and healthy diet with plenty of fruits, vegetables and fiber.
Avoid highly processed foods and artificial additives such as colorings. In the long term, these can weaken the immune system and thus promote skin inflammation, among other things.

You should also avoid stimulants such as alcohol and nicotine. The substances damage the skin's natural protective shield and make it more susceptible to pathogens.

Covering up the skin changes

The reddened and flaky skin with pustules and papules on the face is a cosmetic problem for many sufferers and creates a high level of suffering.The resulting stress can exacerbate the clinical picture. Therefore, if you want to cover the affected areas of skin with cosmetics, you should consult a doctor or pharmacist in advance about suitable products. Because ordinary make-up can make the symptoms worse.

Perioral dermatitis: course and prognosis

Without treatment, the disease can last for several months. However, if perioral dermatitis has been correctly diagnosed and the patient adheres to the medical treatment recommendation, the prognosis is good. With the right cleaning and the right care products, the inflammations usually heal within a few weeks. Perioral dermatitis usually does not leave any scars.

Tags: drugs prevention gpp