Skin Exposed around the mouth, nose or eyes? It could be perioral By Katherine McDonald and Dr. Nordau Kanigsberg

Perioral dermatitis is a rash that appears Diagnosis and risk factors Treatment around the mouth (most often), the There are no specific tests for Mild will usually folds of the nose and occasionally the diagnosing perioral dermatitis because clear up in a few weeks, if triggers are eyelids. The rash is formed of groups the clinical presentation is very typical avoided. Topical therapy (i.e., eryth- of tiny red bumps resembling little and easy to recognize. The exact cause romycin, clindamycin, , blisters or pustules. The immediate of the condition is unknown, but tacrolimus or azelaic acid) can be used skin bordering the lips, nostrils and possible factors include a weakened to treat mild perioral dermatitis. The eyelid margins is usually unaffected skin barrier, activation of the body’s evidence for metronidazole cream is and looks paler than the affected skin. immune system or an imbalance in weak, and this is therefore not an ideal In addition to the tiny red bumps, the good (microflora) and bad bacteria treatment option. some people have dry and flaky skin. on the face. The most important antibiotics are the Individuals with perioral dermatitis triggers of perioral dermatitis include most effective treatment for perioral occasionally feel a burning sensation steroids (creams, nasal sprays, oral dermatitis. However, erythromycin is or an itch in the affected area. In more steroids or puffers) and fluorides in effective in children. If antibiotics prove severe cases, the bumps can be larger toothpaste. Several other triggers have to be ineffective then you might be and form clusters. Those who develop also been reported by patients (e.g., prescribed oral low-dose isotretinoin. perioral dermatitis are usually between hormonal changes and use of makeup, 15 and 45 years old, but it can be seen synthetic sunscreens and face products Emotional and psychological in children. Girls and women are more containing chemical irritants), although impact likely to be affected by the condition there isn’t much research-based Because of its location on the face, (90 per cent of cases). evidence for these. perioral dermatitis can be difficult to hide and therefore a very distressing condition. If you have this condition then you might feel embarrassed and TIPS to reduce flares want to hide away when the rash flares. To minimize the emotional 4 Avoid using corticosteroid creams on your face.** impact, try to recognize the condition early, avoid triggers, and speak openly 4 Use fluoride-free toothpaste.** and honestly with your physician. cs 4 If using fluorinated toothpaste, cleanse around the mouth after brushing.* Katherine McDonald, BScH, is a second- 4 Avoid applying foundation or concealer directly over the affected area.* year medical student at the University 4 Use gentle face products (i.e., free from sodium lauryl sulfate).* of Ottawa. She is an executive of the 4 Use a physical-blocker (as opposed to a chemical) sunscreen.* and Pediatric Interest Groups, and a research assistant at the Children’s 4 If you have a rash around the eyelids, avoid eye makeup entirely.* Hospital of Eastern Ontario. 4 Stay away from internet remedies.* Nordau Kanigsberg, MD, FRCPC, has a private dermatology practice in 4 Try not to scratch or pick at the rash.* Ottawa as well as teaching clinics at the 4 Avoid exfoliating the flaky skin (aggravating).* Ottawa Hospital and Children’s Hospital (**Good evidence, *patient feedback [unscientific]) of Eastern Ontario.

10 canadianskin.ca Fall/Winter 2016

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