Granulomatous Perioral Dermatitis in Children

Abstract

Five children, aged 3 to 11 years, developed a distinctive perioral, perinasal, and periorbital rash, consisting of tiny, closely spaced, flesh-colored "micronodules." Histopathologic examination in all five cases revealed upper dermal and perifollicular granulomas admixed with lymphocytes. There were no associated systemic abnormalities. The lesions resolved after months to years, leaving no scars. We propose that this condition is a form of perioral dermatitis with granulomatous histologic features, which can be distinguished from sarcoidosis and other facial eruptions in childhood both on clinical and histologic grounds.

The granulomatous reaction pattern

“…234,235 Perioral dermatitis chiefly affects young women, but it has also been reported in children. [236][237][238][239] In a recent review of patients with lip and perioral area dermatitis, Nedorost has presented a useful table with the distinguishing features between a rosacea-type of perioral dermatitis, a steroidinduced type, and disease due to irritants, allergic/photo allergic contact reactions, and atopic cheilitis. 240 She suggests that an extended patch test series may be useful in making a diagnosis.…”

“…230,236 Others have found the epidermal changes to be more prominent than in rosacea, consisting of parakeratosis, often related to hair follicle ostia, spongiosis, which sometimes involves the hair follicle, and slight acanthosis. 230,236 Others have found the epidermal changes to be more prominent than in rosacea, consisting of parakeratosis, often related to hair follicle ostia, spongiosis, which sometimes involves the hair follicle, and slight acanthosis.…”

Extrafacial and Generalized Granulomatous Periorificial Dermatitis

“…17 A case of GPD was reported in a girl who later developed a more acneiform and telangiectatic form of rosacea (Judith Schiffner, MD, oral communication, February 2001). 8 Arguably, GPD may actually be a variant of granulomatous rosacea and, in a subset of patients, the first manifestation of a rosacea diathesis.…”

Demodicidosis as spinulosis of the face – a therapeutic challenge

“…The prevalence of Demodex in normal human hair follicles is age related. It is unusual in children, except for a few cases associated with HIV 3 and immunosupresion, 4 and is very high, almost 100%, in people over 70 years of age 5 . Demodex infestation is not manifested unless local or systemic immune function is altered, leading to the proliferation of the organism and subsequent disease, including granulomatous rosacea, granulomatous perioral dermatitis, pustular filliculitis, papulopustular dermatosis of the bald scalp, blepharitis, solitary granuloma and recently described follicular spicules of the face 6,7 .…”