05/02/2026
PERIORIFICIAL or PERIORAL DERMATITIS
Presentation: Looks like acne and eczema. Grouped erythematous papules, pustules, patches, or macules—with or without scale—typically distributed around the mouth (sparing of the vermilion of the lips), perinasal and periorbital. Burning and stinging sensations.
Triggers: Overgrowth of commensal skin organisms such as Fusobacterium fusiformis, Spirillum species, and Demodex folliculorum, Neisseriales, Corynebacterium, Cutibacterium, and Staphylococcus Corticosteroids exposure (topical such as hydrocortisone cream, intranasal such as Flonase, inhaler such as Advair, systemic such as prednisone) Hormonal factors, including contraceptive use, pregnancy and premenstrual flares Occlusive emollients (paraffin, petroleum-based, lanolin such as in Aquaphor, sunscreen, cosmeceuticals) Fluorinated toothpaste (stannous flouride) Rosin, a common ingredient of flavored chewing gum! UV light, heat, wind, and saliva.
Treatments: Zoryve/Vtama,
Pimecrolimus cream,
Tacrolimus ointment,
Opzelura/Anzupgo. Metronidazole gel,
Azelaic acid gel (Finacea),
Clindamycin lotion,
Benzaclin,
Sulfacetamide lotion Ivermectin gel (Soolantra)
* 4 to 8 weeks of topical regimen to get improvement. When improvement is observed, therapy can be tapered or discontinued. Oral:
Sarecycline (Seysara),
Doxycycline,
Azithromycin,
Ivermectin (single dose),
Isotretinoin.
* Risk of recurrence
* Importance of ongoing trigger avoidance.
* Some patients can have persistent low-grade activity for years, characterized by intermittent, unpredictable exacerbations.