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InflammatorySteroid-inducedICD-10 L71.0

Perioral dermatitis

Periorificial dermatitis · steroid-induced rosacea-like dermatitis

Perioral dermatitis is a chronic eruption of small grouped erythematous papules and pustules around the mouth — sparing the vermilion border — that may extend to the perinasal and periocular regions (perioral / periorificial dermatitis). Classically affects young women but also occurs in children. Topical corticosteroids and fluorinated dental products are the most important triggers. It is a very common rosacea-mimic and important steroid-related complication in patients who have received facial corticosteroids for unrelated skin oncology indications (e.g. post-Mohs scars, BAD-managed eczema).

CurrentLast reviewed 16 May 2026

Triggers and pathogenesis

  • Topical / inhaled corticosteroids (commonest trigger) — onset typically weeks to months after starting; flares on withdrawal.
  • Heavy occlusive moisturisers, sunscreens, cosmetics.
  • Fluorinated toothpaste, mouthwash.
  • Oral contraceptives, hormonal fluctuation (pregnancy, menstrual).
  • Demodex folliculorum / candida overgrowth implicated in some cases.
  • Female young adults predominant; paediatric variant also recognised.

Clinical features

  • Small (1-2 mm) erythematous papules / pustules / fine scaly plaques.
  • Symmetric distribution around the mouth.
  • Characteristic sparing of the vermilion border (clear margin 3-5 mm wide).
  • Periocular and perinasal extension common ("periorificial dermatitis").
  • Mild pruritus, burning; cosmetic distress prominent.
  • Course: months; recurrent if steroid trigger continued.
  • Granulomatous variant (more common in children, particularly skin of colour): flesh-coloured / red-brown discrete papules.

Differentials

  • Acne vulgaris — comedones present; broader distribution.
  • Rosacea — central face, telangiectasia, vermilion not specifically spared.
  • Contact dermatitis — pruritus dominates; geometric.
  • Seborrhoeic dermatitis — greasy scale, nasolabial.
  • Demodex folliculitis.
  • Lupus malar rash.

Management

  • Stop the trigger:
    • Discontinue topical / inhaled corticosteroids (counsel about expected flare); switch inhaled steroids to spacer; change toothpaste to non-fluorinated.
    • Stop occlusive cosmetics and moisturisers.
  • Bland skincare: gentle non-soap cleanser; bland emollient if needed.
  • Topical first-line: metronidazole 0.75% gel/cream BD, azelaic acid 15-20%, ivermectin 1%, erythromycin 2%, pimecrolimus 1%.
  • Oral: tetracyclines (lymecycline, doxycycline, oxytetracycline) for 6-12 weeks if topical inadequate.
  • Paediatric: oral erythromycin / clarithromycin (tetracyclines contraindicated <8 years).
  • Counsel about delay before resolution (2-3 months); pre-warn of initial rebound.

References

  1. Tempark T, Shwayder TA. Perioral dermatitis: a review of the condition with special attention to treatment options. Am J Clin Dermatol. 2014;15:101-113.
  2. Hafeez ZH. Perioral dermatitis: an update. Int J Dermatol. 2003;42:514-517.
  3. Tolaymat L, Hall MR. Perioral dermatitis. StatPearls. Treasure Island: StatPearls Publishing; 2023.
  4. British Association of Dermatologists. Periorificial dermatitis — patient information leaflet. London: BAD; 2022.

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