Perioral dermatitis

Perioral dermatitis frequently occurs in young and middle-aged women. However, the condition can also affect men, people of any other age, and even young children, although it is predominantly seen in people between the ages of twenty and forty. 0.5 – 1 % of the population are estimated to suffer from it. Perioral dermatitis is an inflammatory disorder of the facial skin and typically results in reddish papules (bumps) in the area of the mouth (perioral) and/or eyes (periorbital).

In more severe cases, the skin lesions may occur all over the face. Typically, a narrow margin bordering the lips is omitted. Dry skins are more frequently affected by perioral dermatitis and sufferers often have a mild atopic disposition, and so, in many cases, they have made intensive use of cosmetic products to care for their facial skin beforehand.

The probable cause of perioral dermatitis is chronic over-moisturizing and softening of the horny layer of the epidermis by cosmetic creams. This leads to a disturbance of the barrier function and dehydration of the outer skin layers, which, in turn, results in the non-infectious, harmless, but from an aesthetic point of view, often very perturbing skin lesions. In many cases, the facial skin is slightly swollen and looks wan. It sometimes has large red areas and sometimes red patches. It has numerous small red bumps (papules) which may merge into one another. This makes the surface of the skin appear uneven and “grainy”. If the epidermis has been over-moisturized for a prolonged period, an increase in the bacterial flora of the hair follicles may result and, with this, the appearance of small pustules. The redness can vary, depending on the degree of inflammation, from almost flesh-colored to pale red, right through to dark red. Flaking may also occur.

Sufferers complain of dryness, a feeling of tightness and, sometimes, stinging, and tend toward increased application of moisturizing care creams. This intensifies the skin lesions and symptoms and the perioral dermatitis becomes chronic. In the hope of improvement, many sufferers change their care products very frequently, thereby continuing the vicious circle. Sunlight and artificial UV rays may worsen perioral dermatitis, but they are not primary triggers.

The most important prerequisite for successful treatment of the disorder is to completely stop use of all your own cosmetic care products. Since doing this abruptly will very probably worsen the skin’s condition, it should be carried out successively and slowly over a number of days. To assist the process, application of black-tea poultices several times a day is recommended (the tanning effect of black tea alleviates irritation). Commercially available black tea, cooled and strong, can be used for the poultices. Creams or gels containing antibiotics, or a formulation consisting of metronidazole 1 - 2 % in a base that is not too oily and, if possible, free of preservatives and fragrances, are also suitable for topical (external) use. In severe cases, internal antibiotics may be necessary. External corticosteroids (cortisone preparations) are contraindicated (not suitable). After briefly improving the disorder, these regularly worsen the skin’s condition when attempts are made to discontinue use, thereby leading to a dependency of the skin on cortisone.

In the period in which the sufferer is gradually ceasing to use their existing care creams, temporary worsening of the condition of the skin, with a subjective feeling of dryness and tightness, regularly occurs, and lasts approximately 2 weeks. However, this is part of the healing process. It is important that moisturizing care products are used in this phase as often as necessary, but as rarely as possible. This is the only way the softened horny layer will have the opportunity of regenerating itself. Over time, the skin will require care creams less and less so that the healing process will be able to take effect. In most cases, perioral dermatitis clears up with these measures within a period of up to approximately 8 weeks.

Basic dermacosmetic care:

For the basic care of skins with perioral dermatitis, the principals “less is more” and “as much as necessary, as little as possible” apply. Creams and gels that are low in oil and free of fragrances and parabens should be used as far as possible. Care products should only be applied if they are required, i.e. if the skin feels exceptionally tight and dry, and not at specific, regular times of day as well. This is the only way to reduce frequency of use to the minimum required. Once the skin has settled down again and the lesions have cleared up, basic care products can again be applied at regular times of day.

Sources:
Braun-Falco, Plewig, Wolff, Burgdorf, Landthaler: Dermatologie und Venerologie, 5th edition, 2005, Springer Medizin Verlag Heidelberg
Fritsch: Dermatologie und Venerologie, Lehrbuch und Atlas, 1998, Springer-Verlag Berlin Heidelberg

 

DADO SENS care recommendation:

  • Basic care:

ProBalance

  • Severely irritated areas/pimples:  

ProBalance Akut Soothing Acute Cream

  • Sun protection/skin care:

Sun Gel SPF 15 / Sun Gel SPF 25, After Sun Gel