Perioral dermatitis: a 12-year review

Abstract

SUMMARY A continuing study of perioral dermatitis over a period of 12 years is presented. A distinction is made between various patterns of circumoral and paranasal dermatitis and the clinical picture that we describe as ‘perioral dermatitis’. No cases were seen before 1966 but the number of patients presenting to hospital clinics or in private practice rose dramatically until 1970–1972, after which there has been a progressive fall in numbers. In this period, 259 patients were diagnosed as having the condition and of these 203, resident in an area of some 275,000 population and seen by one or other of us on at least two occasions, form the basis of this study. There were 173 females, fifteen males and fifteen children under 12 years of age. In many cases it was possible to suggest the primary lesion for which patients sought treatment. In sixty‐nine patients this consisted of a para‐oral eruption on the side of the chin and, in forty‐one a paranasal erythematous dermatitis. The characteristic appearance and spread of the eruption to the glabella and eyelids are described. A few patients, mostly male, showed lesions around the eyelids only, from treatment of seborrhoeic dermatitis. All but nine of the patients acknowledged the use of potent (not necessarily fluorinated) topical corticosteroids over long periods; in many cases these were self‐administered. Some of the children had been treated with preparations intended for their mothers. The numerous aetiological agents that have been incriminated as causes of this eruption are examined. We believe that the prolonged use of topical potent corticosteroids is the only one tenable from our observations. The role of hormonal factors and of local irritant agents is examined in this context. Tetracyclines are curative in the great majority of patients in 6 weeks if local corticosteroids are discarded. Relapses are rare. Perioral dermatitis is a most satisfying condition to treat but several questions remain unanswered. The current ‘revolt’ against all forms of cortisone may enable us to answer some of these in the near future.

Critical Appraisal of Reports on the Treatment of Perioral Dermatitis

“…We found 30 studies [4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33] to contain at least partly appropriate information about the treatment of POD (table 3). The quality evaluation based on principles of evidence-based medicine [36] only revealed 2 studies with a medium-range score of 4 [5, 6] and the remaining 28 studies with scores between 0.5 and 2.5 (tables 1, 3) which we regarded to be of low quality.…”

“…The aim of the study was more or less clearly defined only in some papers [4,5,6,7,8, 10, 12,16,17,18,19,20,22,23,24,25,26,27,28,29,30,31,32] awarded with 1 point.…”

“…According to the other randomised studies, 9% [5] and 18% [6] of the patients did not return for follow-up. The other papers received 1 point [12, 13, 18, 22,24,25,26, 29], 0.5 point [7,8,9,10,14,15,16,17,19,20,21, 23, 28, 30, 32, 33] or a score of 0 [11, 27, 31]. …”

“…A reasonable statistical analysis was not possible because of lack of pertinent data and the low level of evidence found in most papers [4,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33] and since the 2 papers with medium-range quality [5, 6] were different in several respects. …”

“…Up to February 2004, sources for this study were Medline (1964–2004), Embase (1966–2004), the Central Register of Controlled Clinical Trials (Central) of the Cochrane Library (1971–2004) and the 526 references of 3 textbook articles [1,2,3], the 30 papers cited in this study [4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33] and 2 recent reviews [34, 35]. In Medline and Embase, 125 out of 215 and 296 out of 454 articles, respectively, were found referring to ‘perioral (and) dermatitis and therapy’.…”