Methods for the treatment of perioral dermatitis on the face in adults and children. How to quickly identify the cause and effectively treat oral dermatitis Perioral dermatitis around the nose

Rashes on the skin near the mouth are medically known as perioral dermatitis, also known as steroid. The disease affects women under the age of 40 and children. In men, perioral dermatitis is less common. The number of episodes of this type of dermatitis decreases every year, which is associated with the use of modern anti-allergenic drugs that stop inflammatory reactions.

Etiology of perioral dermatitis

The disease is not fully understood. The exact causes have not been established, but provoking factors that aggravate the course of the disease are known. These include:

• intense exposure to ultraviolet radiation;
• chapping and peeling of the skin of the face;
• hormonal changes in women and the use of oral contraceptives;
• fungal infection of the skin and hair follicles;
• tendency to allergic reactions;
• decrease in the barrier functions of the skin;
• abuse of fluoride toothpastes;
• disturbances in the work of the central nervous system and gastrointestinal tract.

Poor-quality cosmetics can provoke perioral dermatitis. In case of hypersensitivity, creams containing paraffin, cinnamon flavor, sodium lauryl sulfate should be avoided. If in women the disease develops more often due to internal disorders, then in men, cosmetic products act as provocateurs - shaving creams and foams, lotions, beard care preparations.

The causes of perioral dermatitis may lie in a general weakening of immunity, inaccuracies in nutrition, and non-compliance with the rules of personal hyena. But these are not the main provocateurs of the disease, but soon aggravating factors. There is still no clear understanding of the difference between rosacea and dermatitis. Some doctors consider perioral dermatitis to be a type of acne rosacea.

Perioral dermatitis in a young child may be caused by the use of steroid drugs. Salivation, licking of the lips and chin by children provokes inflammation of the perioral tissues.

Clinical picture

With perioral dermatitis, red rashes resembling pimples form on the surface of the skin. They merge, forming expanded inflamed areas. The affected area is the area around the mouth. In exceptional cases, the cheeks and chin become inflamed, and almost never the eyelids.

The main symptoms of perioral dermatitis include:

• the presence of tuberculate points, which, after healing, retain pigmentation;
• absence of pain;
• ulceration of purulent acne with prolonged inflammation;
• the appearance of thin whitish scales on the surface of the face.

The rash does not cause any particular discomfort. In 25% of cases, subjective sensations are absent altogether. The main problem is the aesthetic imperfection of the skin. With increased sensitivity of the skin, irritation and slight itching are observed. When opening abscesses, the risk of secondary infection increases. The disease becomes chronic. A pink border remains at the site of the lesion even after the acute inflammation subsides.

Diagnostics

Dermatoscopy allows assessing the condition of the skin. During the study, it is possible to determine the structure of formations, the dynamics of their growth, color. During a dermatological examination, the doctor differentiates perioral rashes from other skin diseases: acne, herpes, eczema. In the course of differential diagnosis, it is possible to identify the disease from diffuse neurodermatitis, atopic and seborrheic dermatitis, and demodicosis.

Before understanding how to treat perioral dermatitis, you need to decide on the causes of its occurrence and complicating factors. Often the disease occurs against the background of latent inflammatory diseases of a chronic nature. A single pathogen has not been identified. To clarify the nature of the disease, a scraping is performed from the site of the lesion, followed by microscopic examination.

Steroid dermatitis on the face can be caused by coccal allergens, as well as fungi. Most often, the face is affected by fungi of the genus Candida, less often - mold fungi. Bakposev makes it possible to accurately select the subsequent therapy, taking into account the sensitivity of the pathogen.

Therapeutic measures

The causes and treatment of any disease are interrelated. Due to the lack of information regarding perioral dermatitis, it is difficult to name a universal and effective treatment. If rashes near the mouth signal hidden diseases, then therapy begins with their elimination. At the same time, they enhance facial skin care and adjust nutrition. Diet for perioral dermatitis involves the rejection of alcohol, carbonated drinks, smoked foods.

Since the disease often has an allergic nature, all products that provoke negative reactions are prohibited. This group includes citrus fruits, exotic dishes, honey, chocolate.

You can expand the diet at the expense of lean meat, dairy products, cereals. From fruits and vegetables, light apples, pears, turnips, zucchini, green peas, cabbage, cucumbers will be useful. A vegetarian diet is the best option for perioral dermatitis at any stage. But in childhood, lean meat is indispensable. Beef, turkey and rabbit are not contraindicated in this disease.

How to treat perioral dermatitis, a qualified dermatologist will tell you. At the same time, the help of an endocrinologist, neurologist, immunologist, gastroenterologist may be required. Complex therapy involves taking medications, treatment with physical factors, proper skin care.

Medical treatment

With dermatitis on the face, the emphasis is on external processing. For this purpose, healing and soothing agents are used. If the patient was treated with corticosteroids for the period of the appearance of rashes, then the therapy is stopped. Inflammation usually resolves naturally. Resuming steroid treatment is dangerous. Therapy is adjusted and less aggressive drugs are prescribed.

Proper care plays an important role in the restoration of the skin. Soothing and cooling creams relieve redness, relieve itching. Zinc ointment enhances trophic processes and stimulates cell renewal. Its use is advisable for severe inflammation. Zinc ointment is prescribed for a period of 2 weeks. If after this time there is no improvement, a more active treatment of steroid dermatitis on the face is selected.

Often dermatologists prescribe metronidazole for purulent inflammation. It is taken at 0.25 g twice a day. In the first days, an exacerbation of the disease is observed, and then the dermatitis disappears. Replace metronidazole with perioral dermatitis is capable of 2% erythromycin. It is a topical antibiotic tablet. The duration of therapy is usually 8 weeks.

Treatment of perioral dermatitis in children involves the external use of metronidazole preparations. At the same time, ointments with the addition of zinc are prescribed. Emulsions based on plant extracts allow to strengthen the treatment of steroid dermatitis on the face. In the acute period, it is advisable to use naphthalene-tar paste. Treatment with Bepanthen ointment speeds up the healing process. To enhance regeneration, ointments such as Elidel, Radevit, Yam are used.

Physiotherapy

How to treat perioral dermatitis with physical factors? Invaluable assistance at the recovery stage will be provided by such procedures as:

• laser therapy - eliminates swelling, improves trophic processes, stimulates capillary blood circulation, increases the barrier functions of the skin;
• cryomassage - activates tissue metabolism, helps cleanse the skin, prevents the appearance of pigmented areas;
• medicinal phonophoresis - reduces the healing period, stops inflammatory reactions, normalizes cellular metabolism, prevents the exacerbation of the disease.

When perioral dermatitis is a consequence of problems from the central nervous system, electrosleep, magnetotherapy, and electrophoresis are prescribed.

Traditional medicine recipes

It remains to find out how to treat perioral dermatitis with traditional medicine. The use of herbal remedies without the consent of a doctor can lead to the opposite result. It is especially dangerous to be treated with folk remedies in childhood and with allergic dermatitis.

To cleanse the body, increase immune defense, enhance regenerative processes, take an infusion with fennel and licorice. For its preparation, take 2 tbsp. l. fennel fruits and chopped licorice root, add 1 tbsp. l. buckthorn bark, rhizomes of burdock and dandelion. For 1 liter of water take 2 tbsp. l mixture. Simmer over low heat, insist and drink half a glass before each meal.

Other recipes will help to defeat perioral dermatitis:

• soothing compress - in equal proportions combine horsetail, licorice root, thyme, oregano, nettle, violet. For 300 ml of water, take a tablespoon with a slide, bring to a boil, leave to cool, wrapped in a towel. Compresses are made from cotton pads or gauze, leaving on the face for 10 minutes;
• decoction for washing - a natural decoction can replace cosmetics, which is used to rinse the face 1-2 times a day. To do this, mix the herbs of yarrow, calendula, St. John's wort and chamomile. For 4 st. l. mixtures take 1.5 liters of water. Washing with warm decoction is recommended not only during the period of exacerbation of dermatitis, but also for its prevention. After the procedure, the face is blotted with a paper towel;
• oil for skin care - take 3 tbsp for a glass of olive oil. l. crushed St. John's wort, insist, periodically shaking, 21 days. Strain and store in the refrigerator. Before applying to the face, the oil is heated to room temperature;
• anti-inflammatory compress - for its preparation, marshmallow root, inflorescences of sweet clover and chamomile are mixed in the same amount, a quarter cup of dry herbs is poured with 500 ml of boiling water, insisted for an hour. You can apply to the face both cotton pads dipped in infusion, and gruel with herbs squeezed through gauze.

Treatment of perioral dermatitis will be effective if you approach the issue comprehensively. Using all the proposed methods will quickly stop dermatitis and prevent its reappearance. A complete list of therapeutic measures is selected by a dermatologist, taking into account age, concomitant diseases and the individual characteristics of the patient.

Perioral dermatitis refers to sluggish and difficult to treat ailments. You should not count on a quick relief from inflammation. The minimum duration of therapy is 6-8 weeks. It will take several months to eliminate residual effects (hyperpigmentation, pimples).

The causes of perioral dermatitis, also called perioral rosacea, are still unknown. However, there are known risk factors that together can lead to the appearance of oral dermatitis:

• the use of creams and ointments containing steroid hormones, such as prednisolone. This reason leads to the appearance of a rash most often, therefore, prolonged use of this group of funds is considered one of the diagnostic signs;
• the use of decorative cosmetics (foundation, makeup base or lipstick) that include potential allergens. Due to the fact that cosmetics play a significant role in the pathogenesis of the disease, perioral dermatitis, the photo of which you can see below, is sometimes called the “stewardess disease”;
• negative impact of natural factors (high humidity, frost or excessive insolation). The disease may appear after moving to another climatic zone or with a sharp change in weather;
• perioral rosacea is often observed in patients suffering from disorders of the gastrointestinal tract, for example, prolonged constipation, dysbacteriosis, gastric and duodenal ulcers;
• often the main cause of the development of the disease are microorganisms that live in the hair follicles. These can be fungi or bacteria, which are often found in the analysis of data from bacteriological seeding of the contents of the rash. However, specific microorganisms that cause dermatitis could not be found;
• perioral rosacea is exacerbated during periods of stress or after strong emotional upheavals. Most likely, this is due to violations of the neurohumoral regulation of the body;
• the use of low-quality toothpastes containing fluorine leads to the appearance of a rash;
• of considerable importance in the occurrence of a rash is the state of the endocrine system. Oral dermatitis in women often occurs during the period of premenstrual syndrome, while taking oral contraceptives, or with hormonal disorders.

Cosmetics play an important role in the occurrence of perioral dermatitis. Especially "dangerous" are:

• products with the smell of cinnamon;
• cosmetics based on vaseline and paraffin;
• products containing sodium lauryl sulfate.

Most often, women under the age of 40 suffer from the appearance of a rash around the mouth. In men, perioral rosacea develops in rare cases.

Symptoms

The main symptoms of the disease are as follows:

• burning sensation and tightness of the skin in the lips. The burning sensation is most pronounced in the area of ​​\u200b\u200bthe fold between the mouth and nose;
• around the red border of the lips, rashes appear in the form of red papules filled with liquid. Papules can be located singly or in groups;
• the skin around the mouth becomes inflamed. On the inflamed areas, small scales are formed, which fall off over time. It is not recommended to remove the scales on your own: this can lead to the appearance of scars or hyperpigmented areas of the skin;
• one of the most characteristic symptoms of perioral dermatitis is a thin clean strip of skin around the lip line;
• if the affected areas become infected, the rash turns into abscesses.

People who develop dermatitis on the face often experience severe psychological discomfort. Worrying about a cosmetic defect leads to the fact that patients stop communicating with others, become isolated and even quit their jobs. Therefore, treatment should not be delayed, otherwise damage to the skin may become irreversible and unattractive scars will appear on the face. Especially often this happens if a bacterial infection joins the dermatitis.

Diagnostics

Perioral rosacea

To diagnose perioral dermatitis, a dermatological examination and dermatoscopy are performed. It is important to remember that dermatitis in women is easily confused with acne, rosacea, demodicosis, acne, as well as atopic and contact dermatitis. Therefore, before starting treatment, it is necessary to consult a specialist.

Clinical tests for the diagnosis of perioral dermatitis are rarely prescribed. This is due to the fact that changes in the biochemical parameters of the blood are not typical for the disease. Sometimes, when a bacterial infection is attached, an increase in the erythrocyte sedimentation rate is noted.

To determine the microflora of the affected skin areas, bacteriological seeding of the contents of the papules is performed. Often, patients are found to have fungi of the genus Candida, but doctors do not attribute them to the causative agents of the disease. It is believed that infection with a fungus is a predisposing factor, and not the cause of the development of oral dermatitis.

Perioral dermatitis during pregnancy

Often, perioral dermatitis on the face in women appears during pregnancy. This is due to the following factors:

• a change in the hormonal background associated with the adaptation of the body to the bearing of the fetus;
• physiological decrease in immunity observed in the first months of pregnancy.

The disease usually appears in the first trimester of pregnancy. Antibiotics and many other drugs cannot be used to treat dermatitis during this period. Therefore, an individual treatment plan is developed for each patient.

Often, dermatitis resolves without treatment after the end of the period of physiological immunodeficiency of pregnant women. However, if the rash causes severe discomfort, you should consult a doctor. Treatment of perioral dermatitis on the face during pregnancy without prior consultation with a doctor is unacceptable.

It is important to remember that the places where the rash is localized in pregnant women tend to be abundantly pigmented, which can lead to the appearance of a cosmetic defect. Therefore, with oral dermatitis, pregnant women should avoid exposure to direct sunlight.

Features of the course of perioral dermatitis in children

In children, perioral dermatitis on the face has its own characteristics. The rashes are rarely red; they are usually pink or brownish. Therefore, children are required to carry out bacteriological seeding of the contents of papules and dermatoscopy to clarify the diagnosis and exclude contact or atopic dermatitis. Most often, oral dermatitis in a child proceeds without discomfort. In rare cases, there is itching in the area of ​​the rash.

Perioral dermatitis in a child is usually associated with the use of inhalers and sprays, which include glucocorticosteroid hormones. It is important to note that during the period of treatment with glucocorticosteroids, the symptoms of oral dermatitis are usually absent: the disease debuts a few days after the end of therapy. Pediatricians also note that perioral dermatitis in infants can develop after using a pacifier in frosty or windy weather. Some doctors associate dermatitis in children with caries: in the child's body there is a chronic inflammatory focus that reduces immune defenses and leads to a rash.

Perioral dermatitis in a child requires consultation with a pediatrician: the appearance of a rash may indicate changes in hormonal levels or a decrease in immunity.

Therapy

Perioral dermatitis in a child

In order to prescribe treatment for perioral dermatitis on the face, the doctor needs to determine the cause of the disease. If dermatitis is caused by the use of ointments that include corticosteroids, the patient should stop using these drugs. Therefore, at the first stage of treatment, a number of patients experience withdrawal syndrome, characterized by severe itching and swelling of the affected area.

At this stage, patients may decide to return to the use of steroid-containing products. However, this is unacceptable: the symptoms of oral dermatitis return in an even more severe form, and any ointments for dermatitis should be used after consultation with the attending physician.

It is recommended to refuse cosmetics, it is especially important to stop using tonal creams and makeup bases for a while. It is acceptable to use creams that include sunscreen components.

High efficiency in the treatment of perioral dermatitis is shown by drying agents, for example, ointments, which include zinc. Such ointments for dermatitis, such as Zinocap or Zinodol, quickly relieve itching and help to quickly get rid of the rash.

To get rid of discomfort, antiallergic drugs are used. Due to the fact that the occurrence of oral dermatitis may be associated with experienced stress, sedatives are prescribed.

Washing products containing sodium lauryl sulfate are completely excluded. To cleanse the skin of the face, you can use oil-based products. If the disease is mild, it is possible to wipe the affected areas with decoctions of medicinal herbs, for example, chamomile.

If the disease is complicated by a bacterial infection, antibiotics are prescribed. The duration of their reception is determined by the doctor. Usually the course of antibiotic therapy is from two to three months. Additionally, as needed, immunomodulating agents are prescribed, as well as drugs that restore the microflora of the gastrointestinal tract.

It is important to remember that in the absence of therapy, the rash can persist on the face for several months or even several years. The disease proceeds with exacerbations and periods of remission. Attempts to treat dermatitis on their own with inappropriate ointments lead to the fact that the affected skin becomes thick, rough and bumpy, covered with age spots and inflamed areas. It will be much more difficult to eliminate the consequences of self-medication than to get rid of dermatitis!

Forecast and preventive measures

Oral dermatitis can take several weeks or even months to completely heal. It is possible that in the future, after the use of steroid drugs or low-quality cosmetics, the rash will reappear. It is important that the use of any ointments for perioral dermatitis should be carried out with great care, especially in patients prone to allergic reactions.

• rejection of bad habits. Smoking and alcohol abuse weaken the body, resulting in reduced immune defenses;
• use of cosmetics recommended for patients with atopic or contact dermatitis;
• you can not injure the skin during cosmetic procedures. Scrubbing, exfoliation, or the use of certain face masks can aggravate;
• toothpaste should be carefully selected. Fluoride-containing pastes should be discarded in patients who have had episodes of perioral dermatitis;
• It is important to take multivitamin preparations that help strengthen the immune system. It is advisable to choose products that include B vitamins and vitamin E. These vitamins improve the condition of the skin and contribute to the rapid recovery of areas damaged by dermatitis.

Diet

Patients diagnosed with perioral rosacea are strongly advised to follow a diet that excludes allergenic foods.

In the acute period of the disease, the following products should be preferred:

• kefir, fermented baked milk, curdled milk and other fermented milk products. Yoghurts should be consumed natural, not containing dyes and preservatives;
• cereals boiled in water, with a small amount of salt;
• grain bread;
• lean meat (chicken breast, turkey, etc.).

Strong coffee and tea, alcoholic beverages, smoked and canned foods, as well as dishes rich in carbohydrates are excluded from the diet. It is advisable to reduce the amount of salt consumed. Fruits and vegetables can be introduced into the diet with caution. You can not eat exotic fruits that are strong allergens, it is also necessary to exclude citrus fruits.

Sometimes, to get rid of the disease, you have to completely change your lifestyle: if a person has perioral dermatitis, reviews suggest that the combination of taking antihistamines and a sparing diet becomes the most effective treatment.

ethnoscience

There are a number of folk methods for the treatment of oral dermatitis. It is important to remember that you can resort to such methods only after consulting a dermatologist.

The following are considered the most effective:

• medicinal lotions. For lotions, decoctions of calendula, chamomile and string are used. Soak a gauze pad with warm decoction and apply to the damaged area of ​​the skin. Lotions do not get rid of the rash: they can only significantly reduce the discomfort caused by the disease. However, people prone to allergies should be careful about the use of medicinal plants: they may contain strong allergens;
• linseed oil. The composition of linseed oil includes vitamins that have a beneficial effect on the regenerative capabilities of the skin and its general condition. The oil, heated to a comfortable temperature in a water bath, is applied to a gauze pad and applied to the skin. Flaxseed oil can also be used to cleanse the skin of makeup. On the Internet, advice is often found to use flaxseed oil mixed with honey. However, this recommendation cannot be followed: honey is a strong allergen and can aggravate the course of the pathological process.

Now you know about the causes and treatments for perioral dermatitis. Do not think that a rash around the mouth can be ignored: its appearance can indicate serious malfunctions in your body. Therefore, if suspicious symptoms appear, go to the doctor and strictly follow all his recommendations!

In this article, we will tell you about oral dermatitis (perioral rash) and the causes of its occurrence. You will find out why such rashes most often appear in women. What drugs can not be used for their treatment. How to eat to control the course of this chronic disease. After reading the information, you will be able to distinguish oral dermatitis from other skin diseases with similar symptoms, this will allow you to play it safe and make sure that treatment is in the right direction.

What is oral dermatitis?

Oral (perioral, perioral, steroid) dermatitis - Refers to chronic skin diseases. The pathology manifests itself as a red nodular rash around the mouth, which, without treatment, can spread down to the chin and rise up to the wings of the nose. In advanced cases, such rashes can also appear near the eyes on the eyelids.

Most often, perioral rash affects the skin of women aged 16 to 45 years. A little less often, this form of dermatitis disturbs men. This is due to the fact that they do not use decorative cosmetics. Often, oral dermatitis is observed in young children. Let's see what factors usually provoke the appearance of a rash around the mouth in people of different sex and age.

Causes of rashes

There is no exact cause of oral dermatitis. As dermatological practice shows, the skin around the mouth lends itself to characteristic pathological changes in the cases described below.

Hormonal medications

Treatment of the body with drugs (creams, ointments, tablets, nasal drops, inhalation sprays) containing corticosteroid hormones in its composition, in some cases provokes the appearance of oral dermatitis. Here, as an example, one can cite a spray against the common cold "Fluticasone", tablets with anti-inflammatory and analgesic effects "Prednisolone" and "Sinaflan" ointment, which is usually prescribed for herpes.

A red nodular rash around the mouth can appear even as a result of short-term skin contact with a hormonal medicine. Therefore, it must be taken into account that after using the ointment on any part of the body, a small amount of it remains on the fingers. And if you do not wash your hands thoroughly, then accidentally touching your fingers to the skin of your face can provoke dermatitis.

Note! Some people mistake oral dermatitis (OD) caused by corticosteroid drugs for an allergy. They begin to treat the rash with hormonal ointment, as a result, acne disappears, and after a while they return, but with renewed vigor. Therefore, self-medication should never be done.

Cosmetics and cosmetic procedures

Often, oral dermatitis in women is caused by caring and decorative cosmetics (creams, makeup removers, lipstick, powder, etc.). Especially this condition provokes foundation, which clogs the pores of the skin and thereby disrupts the function of its barrier layer. Initially, the skin becomes dry and begins to peel off, then papular rashes appear on it, characteristic of oral dermatitis.

Note. This form of pathology usually affects the skin of theater and film actors, due to the frequent application of makeup on the face.

Cosmetic procedures such as deep chemical or mechanical cleaning of the skin (peeling) can also provoke the appearance of oral dermatitis. This is due to the fact that in the process of cleaning the skin (especially the dry type) receives microtrauma, as a result, irritation and small pimples appear on it.

Important! The danger of fluorides (fluorine ions), which are part of toothpastes, is that when they get on healthy skin, they cause irritation and slight redness, and with a very sensitive type, they can provoke a condition similar to a first-degree burn.

Oral contraceptives

Contraceptives containing hormones can cause a side effect in the form of a perioral rash.

The oral cavity is a place where there are a lot of bacteria, so you should take good care of this area. Jams may also appear at the corners of the mouth.

Therefore, at the first symptoms of the appearance of dermatitis, it is better to stop taking the hormonal drug and go for a consultation with a dermatologist and gynecologist.

What causes rashes in children?

Usually, the appearance of PD in newborns (breastfeeding), pediatricians explain the increased level of hormones in the mother's blood, which accumulated throughout her pregnancy. Such a rash does not require treatment and passes quickly.

Another common cause of rashes around the mouth in a young child is associated with chapped skin, which occurs if the baby sucks on a pacifier outside in cold weather. Other factors for the appearance of oral dermatitis in children:

• Climate change and weather patterns.
• Weakened immune system.
• Prolonged exposure to the skin of sunlight.
• Violation of the intestinal microflora.

In these cases, the symptoms of oral dermatitis in children may disappear as soon as the general health of the body is restored or it adapts to new weather conditions.

Symptoms

The main symptom of the disease is a rash, which has its own peculiarity in this form of dermatitis:

• Place of localization. The rash appears around the mouth, in most cases the elements of the rash are separated from the lips by a strip of healthy skin. In addition to the perioral zone, the rash can spread down to the chin, up to the nostrils (nasolabial triangle), capture the corners of the lips.
• Amount of elements. At the beginning of the disease, separate pink papules (pimples) appear on the skin. In the absence of treatment, the disease progresses: papules begin to form simultaneously on all indicated areas of the skin, forming pathological islands.
• The nature of the rash. A polymorphic (consisting of different elements) perioral rash is another sign that oral dermatitis has arisen on the skin. The rash is: pimples protruding above the surface of the skin, the tops of some are filled with a small amount of clear liquid, others are drying and scaly papules.
• Pimple size and color. Papules are 2-3 mm in size and have a whitish hue, which is very noticeable, since they are located on red spots that do not have clear contours and appear on the skin in the form of stripes.

If pustules form on the skin during oral dermatitis, weeping and noticeable inflammatory changes appear, then this indicates either improper treatment or a too aggressive course of the disease. In this case, you can not do without the help of a specialist.

Note! A maculopapular rash is able to change its shade under the influence of external factors (air temperature). If you look closely at the areas of skin affected by dermatitis at room temperature, you can see a network of dilated capillaries. In the cold, the capillaries constrict, as a result, the inflamed skin turns pale and acquires a healthier shade. But as soon as the patient enters a warm room, the spots again become red-brown.

Differential diagnosis (how to distinguish oral dermatitis)

A simple diagnosis of perioral dermatitis is based on the patient's medical history, the characteristics of the elements of the rash, and the features of its spread over the skin. If the patient's body does not respond to the current treatment, and the dermatologist suspects that the patient has another disease with similar characteristics, then differential diagnosis is prescribed.

The process involves separating the symptoms of PD from the following inflammatory pathologies:

1. Seborrheic dermatitis. This form of skin pathology, unlike perioral, is more common in men. The rash is localized not only in the area of ​​the beard, mustache, nasolabial folds, but also on the scalp. Peeling scales are yellow and have a greasy sheen.
2. Atopic dermatitis. The disease differs from the oral form by pronounced itching, the appearance of a rash not only on the skin of the face, but also on the folds of the limbs. It is difficult to separate the symptoms of both pathologies when a patient develops perioral dermatitis against the background of atopic, due to the use of hormonal ointments in his treatment.
3. Rosacea (rosacea). This pathology, unlike oral, develops gradually (in the absence of treatment): reddening of the skin - papules (dense red pimples) - pustules with pus - tumor-like abscesses.
4. Contact allergic dermatitis. It differs from the oral one by severe reddening of the skin and the presence of severe itching in the affected areas.

Note! An accurate diagnosis of a skin disease is a guarantee that the process of recovering a patient after an exacerbation will not last for several years.

Medical treatment

Treatment of oral dermatitis is usually started by eliminating the patient's contact with the means that contributed to the onset of the disease (fluoridated toothpaste, hormonal ointment or cosmetics). And if during the day the perioral rash does not begin to disappear, then the patient is prescribed a local treatment:

• Antibiotics - help reduce inflammation.
• Antimicrobials - prevent infection of wounds.
• Keratolytics - prescribed to exfoliate dead skin cells.
• Antihistamines - to relieve itching and swelling.

Important! With oral dermatitis, dermatologists do not recommend the use of hormonal ointments. Such drugs during the withdrawal period only worsen the condition of the skin. As a result, PD has to be treated for years.

Antibiotics

Usually, with oral dermatitis, in order to stop the progression of the disease, patients are prescribed:

• • Gel / cream "Metronidazole" 0.75% or gel "Erythromycin" 2%. To use: Treat inflamed skin in the morning and evening daily until the rash stops reappearing.

• Minocycline tablets are an antibiotic of the tetracycline group (prescribed if the pathology has affected the deep structures of the skin or is characterized as extensive). The dosage is prescribed by the doctor, taking into account the severity of the disease. The drug is taken until the rash disappears.

Note. During the period of antibiotic treatment, the condition of the affected skin may worsen (it thickens), but after 2-3 weeks after the drug is discontinued, its condition returns to normal.

Antimicrobial and keratolytic drugs

As an antimicrobial agent, patients with oral dermatitis are prescribed benzoyl peroxide gel and lotion (Baziron AS, Baziron Control).

The drug inhibits the growth of pathogens by an oxidation reaction and promotes exfoliation of dead cells.

How to apply:

• • Gel "Baziron AS" 5% and 10% - apply a 5% agent to the skin affected by dermatitis 1 time per day for 2 to 3 weeks. Then start using 10% of the drug until the body is completely healed.
  • Lotion "Baziron Control" - wash the inflamed skin in the morning and evening until the rash disappears.

Result: with regular use of these antimicrobial agents, visible improvements occur 4 weeks after the start of treatment. After that, you can switch to a prophylactic regimen of using a gel or lotion (2-3 times in 7 days).

Note! Do not immediately use the highest concentration of benzoyl peroxide (available in 2.5%, 5% and 10%). This will only cause more skin irritation.

Drugs for complication of demodicosis

In the treatment of oral dermatitis complicated by demodicosis (opportunistic subcutaneous mite), the following are simultaneously used:

• • Sulfur ointment 33% - the course of treatment lasts 20 days, the agent is applied to the diseased skin in the morning and evening after washing with soap.
  • Purified sulfur - take orally 0.5 g 3 times a day for 20 days.

Antihistamines

The following drugs can relieve itching, swelling and burning sensation in complicated perioral dermatitis:

• "Suprastin" - suitable for patients of different ages (adults: 1 tab. 3-4 times a day; children: ½ tab. 2-3 times a day).
• "Zirtek" (drops, tablets) - recommended for adult patients for the first 2 days, ½ tablet or 10 drops of the drug per day. Then, if the symptoms of oral dermatitis do not subside, the dose of the drug is doubled (i.e. 1 tab. or 20 drops per day).

Important! Antihistamines should be taken no more than 7 days. The exact course of treatment is prescribed by the doctor, taking into account the history of the disease and the age of the patient, the degree of complexity of the disease.

You can get acquainted with the rules of drug treatment of oral dermatitis and learn about possible side effects by watching the following video:

Folk recipes

An oral rash can be cured within 3-4 weeks with folk remedies, making decoctions and infusions from natural ingredients (medicinal herbs, oak bark, aloe juice, propolis, etc.). The main thing is that the home remedy does not cause you an allergy, especially this factor applies to bee products. You can check the body's reaction to the medicine as follows:

• moisten the swab with the prepared composition (even if it is intended for oral administration) and apply it for 5-10 minutes to the inside of the elbow bend, if during this time a rash, redness appears on the skin, you feel itching or burning, then the medicine is not suitable for you.

Note! It is not necessary to treat complicated oral dermatitis (infectious) only with folk remedies. Without medication, the healing process will stand still.

herbal infusion

Ingredients:

1. Sage.
2. Calendula.
3. Plantain.
4. St. John's wort.
5. Elecampane.
6. Chamomile.
7. Horsetail.

How to cook: take the first 5 ingredients 15 g each, chamomile and horsetail 10 g each (all herbs are sold at the pharmacy). Put the collection in an enameled container, pour 1 liter of boiling water, cover, let the composition brew for 3 hours. Strain the medicine through cheesecloth and pour into a glass bottle.

How to apply: take the composition 3 times a day, 70 ml (after meals), until recovery occurs.

Result: herbal collection includes herbs with antimicrobial, anti-inflammatory and regenerating effect. The first improvement in the condition of the skin can be observed after 5 days.

Ointment from propolis

Ingredients:

1. Propolis - 20 g.
2. Sunflower oil - 80 ml.

How to cook: put the crushed (after the refrigerator it crumbles easily) propolis into the oil and hold the components in the oven until the propolis dissolves.

How to apply: Apply the cooled ointment to the areas of skin affected by dermatitis 3 times a day.

Result: if the skin disease is not running, then it will be possible to get rid of it within 4 weeks.

Honey linen compress

Ingredients:

1. Flaxseed oil - 2 tbsp.
2. Natural honey - 2 tbsp.
3. Onion juice - 1 tbsp.

How to cook: combine all the ingredients and boil them in a steam bath for 2-3 minutes.

How to apply: make a compress of gauze and the prepared composition, hold it on the sore skin for 15 - 20 minutes. The procedure is carried out daily at night until the onset of recovery.

Result: this mixture will speed up the healing of the skin if used as an adjunct to medical treatment.

Question answer

How to exclude the appearance of oral dermatitis?

Since there are many causes of the onset of the disease, and the exact one has not been established, in this case it is best to follow the general rules:

1. Do not use hormonal ointments unless prescribed by a dermatologist.
2. Refuse the regular use of heavy cosmetics (foundation, powder).
3. Moisturize the skin with petroleum jelly, it does not clog pores (you can use pure petroleum jelly, or you can combine 2 tsp with 3 tsp of aloe leaf juice).
4. Wash your face with mild cosmetics (Dove Gentle Exfoliation Cream Soap).
5. Sunlight and wind can aggravate perioral dermatitis. Be sure to protect your skin if you will be in the sun for a long time.

How to treat perioral rash during pregnancy?

Treatment of oral dermatitis in pregnant women occurs according to the following scheme:

1. Avoid cosmetics completely.
2. Wash your face daily with cool water (wipe with ice cubes).
3. Use a decoction of celandine or chamomile to wipe the skin (preparation: 1 tbsp of dry grass, steam 0.5 tbsp of boiling water, strain after 15 minutes).
4. Moisturize your skin with Bepantol Baby Hypoallergenic Baby Cream.
5. Don't use fluoridated toothpaste.
6. At night, treat sore skin with zinc ointment. In the second semester of pregnancy, Metrogil is allowed.
7. Medical supervision is required.

What vitamins should be taken with oral dematitis?

Almost all skin diseases are treated comprehensively. The doctor creates a treatment regimen in which vitamins are necessarily present. Particularly important in PD are the B vitamins, these are pyridoxine, nicotinic acid and riboflavin (they participate in metabolic processes, strengthen the immune system).

Do patients with oral dermatitis need a diet?

Need. Meals should be vegetarian and hypoallergenic. Therefore, eggs, meat products, spicy, fried, smoked, too salty dishes, coffee, chocolate, fresh bread, and muffins are excluded from the patient's menu. The diet should contain only dairy, vegetable and cereal products (cereals and soups, crackers), as well as fresh fruits. Low-fat varieties of fish. Herbal tea, plain water, kefir.

Is it possible to permanently get rid of the perioral rash?

As medical practice shows, this form of skin disease is almost never completely cured. The disease can last for decades. Its symptoms completely disappear, then reappear under the influence of external factors (wind, sun, allergy to cosmetics, etc.).

What to remember

1. With oral dermatitis, the rash appears around the mouth, in the region of the nasolabial triangle, and can spread to the chin.
2. Pathology has no exact causes of occurrence, so the scheme of its treatment can be individual.
3. If you have oral dermatitis, then you are better off following a vegetarian diet.
4. This form of skin disease cannot be treated with hormonal ointments, they first improve the condition of the skin, then the rash appears again, but it becomes more pronounced and does not go away for a long time.
5. Oral dermatitis can be treated with home remedies, which are best used as an addition to medications that a doctor should prescribe.

Manifested in the form of red nodules (papules) and, with rare exceptions, reddening of the skin. The name of the pathology indicates the area of ​​localization of the rash - around the mouth, but quite often, the symptoms of the disease are found at the base of the nose and around the eyes. Diagnosis of the disease is carried out by a dermatologist - the conclusion is made on the basis of an examination of the skin and the results of dermatoscopy; treatment is prescribed taking into account the causes that caused the rash and involves the use of ointments and drugs taken orally, including those with antibacterial properties. Perioral dermatitis and oral dermatitis are equivalent names for the same disease, more often affecting women, but recently often diagnosed in children. There is no consensus among specialists on the question of whether perioral dermatitis is an independent disease or is it a type of rosacea or.

Causes of perioral dermatitis

A rash around the mouth can appear for various reasons. Among which, in the first place is the long-term use of hormonal (corticosteroid) drugs used to treat the patient's rosacea and other skin diseases. In addition, perioral dermatitis can be provoked by:

• hypothermia;
• Tan;
• toothpaste containing fluoride;
• decorative cosmetics and cosmetic products for skin care;
• hormonal changes, for example, during pregnancy and gynecological diseases;
• oral contraceptives;
• diseases of the gastrointestinal tract, such as gastritis.

Symptoms of perioral dermatitis

A rash appears around the mouth, consisting of small red dome-shaped nodules, devoid of purulent contents. The skin on which they are located, both retains its normal color, and may turn red. The same ambiguity is observed in relation to the sensations that arise - in some cases, the rash causes discomfort when a person suffers from itching, burning and a feeling of tightness of the skin, but quite often (in about 25% of cases) there are no such symptoms, and subjective sensations do not annoy the patient. The skin in the lesion loses its smoothness and becomes rough to the touch due to the papules and crusts themselves, which form after some time in their place.

The very location of the papules indicates perioral dermatitis - they are necessarily present in the immediate vicinity of the lips, rashes are also found on the chin, under the nose, in the corners of the mouth and along the nasolabial folds. Moreover, skin lesions can be so extensive that they capture the corners of the eyes, eyelids (lower and upper), as well as the bridge of the nose. Interestingly, the rash never comes close to the red border of the lips - there is always a narrow rim of unaffected skin.

Attention! The crusts formed during the regression of papules cannot be removed from the skin (they must move away on their own) in order to avoid formation in their place.

Diagnosis of perioral dermatitis

The disease must be distinguished from eczema, rosacea, herpes simplex and demodicosis, with which it has largely similar external manifestations, and this can only be done by a dermatologist. An experienced specialist diagnoses oral dermatitis by examining the patient's skin and performing dermatoscopy (examination of the skin using a device that gives 10x magnification). In some cases, external symptoms are not enough, and for an accurate diagnosis of perioral dermatitis, microflora is cultured, taken from the lesion.

Attention! There is no single causative agent of the disease, however, most often yeast fungi and traces of Demodex vital activity are found in patients.

Treatment of perioral dermatitis

Since the main cause of perioral dermatitis is the prolonged (or uncontrolled) use of hormonal agents, including ointments, the first thing to do is to stop all drugs containing corticosteroids. You need to be prepared for the fact that after a few days the appearance of the skin will deteriorate sharply: swelling and redness will appear, and in addition, burning and itching will begin to annoy. Such changes, called “withdrawal dermatitis” by specialists, should not frighten patients, and even more so push them to resume the use of hormonal drugs, as this will only worsen the condition of the skin.

The main thing that the patient should remember: no initiative - only the unconditional fulfillment of the appointments of a dermatologist will help cure perioral dermatitis on the face. Typically, a two-stage treatment program includes:

I stage. Antihistamines: Suprastin, Tavigil, Diazolin, Zirtek, Loratadin, etc., whose action is aimed at stopping itching and burning; sedative (soothing) drugs (Persen, motherwort and valerian tinctures) to relieve nervousness and tension caused by an unaesthetic appearance of the skin. Of the cosmetic preparations, only sunscreens are allowed, and for daily skin treatment - infusions of herbs with anti-inflammatory and soothing effects: chamomile, string, calendula, etc. or 1% boric acid solution. The stage continues until the complete disappearance of the signs of "withdrawal dermatitis".

II stage. Tetracycline antibiotics for a course of antibiotic therapy. These can be, for example, Doxycycline or Monocycline tablets, which need to be taken for quite a long time - up to three months; often the doctor prescribes an ointment with the same active ingredient.

Attention! By itself, perioral dermatitis will not go away - it must be treated, because the rash around the mouth can persist for years. But even with timely treatment, the signs of the disease will disappear only after a few weeks, and antibiotics cannot be stopped, otherwise the rash will appear again. Be sure to complete the entire course of treatment.

If symptoms of the disease are detected, she must definitely contact a dermatologist and follow all the recommendations of a specialist. However, antibiotic treatment can only be started after the end of the breastfeeding period.

Prevention of perioral dermatitis

In addition to eliminating the causes leading to the formation of a rash around the mouth, you should follow the rules that will prevent the recurrence of the disease:

• within two to three months after treatment, refrain from using cosmetic products such as creams and lotions, and also do not use foundation creams;
• avoid cosmetic preparations containing paraffin, petroleum jelly, isopropyl myristate, dyes and preservatives, as well as detergents based on sodium lauryl sulfate;
• use creams with SPF (sun protection factor) all year round;
• adhere to a hypoallergenic diet: exclude smoked and fried foods from the diet, as well as products known for their ability to cause allergies, such as chocolate, strawberries, etc .;
• treatment includes the use of lotions from a solution of 1% boric acid.

Video consultation with a dermatovenereologist

Key points about perioral dermatitis

Disease synonyms	oral dermatitis, perioral dermatitis, steroid dermatitis, perioral dermatitis.
	the use of steroid ointments, hormonal contraceptives; cosmetics; toothpaste with fluoride, external conditions (sun, wind); diseases of the gastrointestinal tract (gastritis).
Symptoms	red spots, papules, peeling, itching.
Diagnostics	visual inspection, dermatoscopy.
	tetracycline antibiotics.
Similar symptoms	rosacea, acne, diffuse neurodermatitis.
Contagiousness (infectiousness)	not contagious.
Contact a doctor	dermatologist.
Treatment with folk methods	impossible, only medical treatment.

Doctors may call perioral dermatitis rosacea-like. The disease is rare, affecting about 1% of people.

Often the disease begins in women from 20 to 40 years. Surprisingly, it is more common in women who carefully monitor their skin.

The disease was first described in 1957, but scientists still argue whether perioral dermatitis is an independent disease or refers to rosacea.

Many people from time to time experience increased dryness and redness of the skin around the lips and in the nasolabial triangle. Dryness is treated with a moisturizer.

But in some cases, attempts to moisturize the skin lead to disastrous results.

Pimples appear on the reddened area, the skin reddens even more, pimples and papules grow over an ever larger area. These are the symptoms of perioral dermatitis.

In the beginning, pain, dryness, burning appear, then the skin becomes covered with small red nodules. Further, the number of papules increases, they merge into plaques.

The skin on the face is covered with transparent, easily falling scales. In the area of ​​inflammation, granulomas may appear - formations that have necrotic areas, in this case we are talking about granulomatous perioral dermatitis.

Not all pimples are the beginning of dermatitis, they can be common acne resulting from clogged pores or poor hygiene.

The most striking sign that distinguishes perioral dermatitis from any other skin disease is the border of healthy skin around the lips.

All rashes are located in the nasolabial triangle, on the chin, cheeks, not approaching the lip border closer than a centimeter.

Perioral dermatitis takes a long time. The disease brings a person mental discomfort. Attempts to get rid of it on their own are unsuccessful.

Self-selected ointments, gels and creams in a cosmetic store or pharmacy do not help. A sick person falls into depression, avoids contact with people, limits the social circle.

In different people, perioral dermatitis can pass with different intensity. In some cases, the case is limited to a few pimples, in others, a severe rash appears.

The Web contains numerous reviews of people who have experienced what perioral dermatitis is.

Causes of Perioral Dermatitis

The exact causes of the disease are unknown, but doctors believe that it is primarily an allergic process.

The appearance of a rash is usually preceded by contact with an allergen, so one of the treatment measures is a special diet.

The diet aims to eliminate from the diet foods that are known to cause allergies.

It is difficult to single out any one allergen that causes dermatitis on the face.

These can be climatic factors, chemicals, medicinal ointments and even tooth powder. Especially often cause oral dermatitis fluorinated toothpastes.

It is well known that oral dermatitis can be caused by corticosteroid (hormonal) ointments, often used to treat dermal conditions such as eczema.

These compounds are highly effective in curing dermatological diseases, however, they change the structure of the dermis, lead to atrophy of the skin fibers, disrupt the color of the skin - this leads to the fact that the skin becomes unable to perform its functions.

Microorganisms penetrate it and cause inflammation, which is expressed in the form of a rash, pustules, acne, which ultimately leads to perioral dermatitis.

The causes of perioral dermatitis can be very different. One of them may be a decrease in immunity due to climate change, or excessive solar radiation.

If a person has allergic rhinitis, asthma, or simply sensitive skin, then he is at risk.

Most patients with oral dermatitis have disorders in the functioning of the gastrointestinal tract and the endocrine system, and there are nervous diseases.

If treatment with hormonal ointment did not lead to the appearance of dermatitis on the face, then you should not flatter yourself ahead of time. A rash on the face appears after the ointment is stopped using.

Also, if you show "independence" and use corticosteroids without a doctor's prescription for the treatment of oral dermatitis, then you need to be prepared for the fact that even if the rash disappears, after the drug is discontinued, it will appear again, while capturing a larger area of ​​​​the face.

Important! Oral dermatitis is not treated with corticosteroid (hormonal) drugs - instead of treating, they contribute to the further spread of the disease.

The causes of the disease may be a change in the hormonal background that occurred as a result of menopause or oral contraceptives.

The hormonal background changes greatly during pregnancy, because of this, the appearance of dermatitis on the face is possible.

It is not possible to fully treat oral dermatitis in pregnant women, but you need to know that it is not harmful to the mother and unborn child.

Treatment of dermatitis on the face

Treatment of any skin disease, including perioral dermatitis, is a lengthy process. The duration of treatment is at least one and a half months. In advanced cases, treatment can last up to three months.

A doctor should treat dermatitis, and the sooner you go to him, the faster a positive result will be obtained.

Treatment, organized according to all the rules and leading to the disappearance of the rash, does not guarantee that perioral dermatitis will not make itself felt more.

Relapses can happen. So, where should you start the treatment of oral dermatitis if the doctor has made this diagnosis?

To begin with, conduct the so-called zero therapy. You need to stop using any cosmetics and medical ointments, fluoridated toothpaste.

After stopping corticosteroids, the rash may progress, but things should improve after a few weeks.

Keeping in mind the allergic nature of dermatitis, antihistamines can be taken during null therapy.

If zero therapy does not help, antibiotics are used. With oral dermatitis, antibiotics are quite an effective measure, they can completely cure this disease.

Your doctor will prescribe a treatment that includes minocycline or doxycycline tablets, as well as tetracycline or metronidazole tablets, or metronidazole cream. Erythromycin gel can be used instead of metronidazole cream.

The results of antibiotic treatment can be seen after three weeks. The skin by this time noticeably improves, but it is impossible to stop treatment ahead of time.

So that antibiotics do not harm the body, during treatment for perioral dermatitis, they additionally drink a course of drugs to maintain the intestinal microflora.

An example treatment plan would look like this:

1. Doxycycline, Minocycline or Tetracycline (dose should be prescribed by a doctor) 2 times a day until the rash disappears, then the dose is halved and antibiotics are taken for another month;
2. Metrogil gel in the morning and erythromycin ointment in the evening.

No skin disease is complete without topical treatment. A well-chosen ointment or gel can relieve symptoms and reduce inflammation.

In the treatment of oral dermatitis, Elidel cream with pimecrolimus, a substance included in the group of immunomodulators, showed good results. The gel is able to reduce the skin's response to the allergen.

Face care for perioral dermatitis

Treatment can be supplemented with various folk remedies. You may need a strict diet, but women are no strangers to restricting food for the sake of beauty.

The diet for dermatitis is that everything that leads to allergies and increases the activity of the sebaceous glands is removed from the diet:

• spicy fatty and fried foods;
• Exotic fruits;
• milk;
• sweets.

The diet limits the use of fish, caviar, mushrooms, salt. Dieting doesn't mean you have to be hungry. Meals should be regular, dishes are prepared from foods that are as saturated as possible with fiber.

1. Lotions from a series, celandine, plantain. Lotions are made three times a day;
2. Compresses with flax oil - linseed oil and honey are mixed in equal amounts, heated in a water bath and a little onion juice is poured. The mixture is moistened with a cloth and applied to the affected areas of the skin;
3. Pumpkin mask. The pulp of the vegetable is rubbed on a grater and gruel is applied to the skin;
4. Homemade ointments containing sulfur and tar.

Good folk remedies for dermatitis are:

• Birch buds;
• decoction of oak bark;
• aloe juice and Kalanchoe;
• horsetail

They wash their face with decoctions of these plants, and why leave the skin to dry naturally without wiping it with a towel.

Bee products help get rid of oral dermatitis. Any bee products have a bactericidal effect and can become medicinal folk remedies.

However, in this case, it is undesirable to use honey for treatment, since it is an allergenic product.

For the treatment of oral dermatitis with folk remedies, it is better to use propolis, making an ointment out of it at home.