Description

• A common facial eruption of women and children
• Presents as tiny, flesh-colored, or erythematous monomorphic papules or pustules around the mouth with characteristic sparing of the area immediately adjacent to the vermilion border
• May also involve the periocular, perinasal, and glabellar regions of the face
• Etiology is unknown, but a relation to topical steroid use has been suggested.
• Without treatment, the course is usually fluctuating and chronic.
• Variants in children include granulomatous periorificial dermatitis (GPD) and facial Afro-Caribbean childhood eruption.
• Synonym(s): periorificial dermatitis (POD); chronic papulopustular facial dermatitis; granulomatous perioral dermatitis; light-sensitive seborrhea; lupus-like perioral dermatitis; papulopustular facial dermatitis; rosacea-like dermatitis; stewardess disease

Epidemiology

• Occurs worldwide, especially in fair-skinned populations
• Predominantly affects children between 6 months and 16 years and women aged 17 to 45 years
• ~90% of adult cases are in women.
• 55% of childhood cases occur in females (1).
• All races are affected, but the granulomatous form is more common in African American and dark-skinned children.
• Some believe the number of cases peaked in the 1960s to 1970s and decreased in the 1980s to 1990s when the side effects of topical steroids were recognized. Others believe that cases are still increasing.

Incidence

• Peak incidence is in the 2nd and 3rd decades of life.
• In children, peak incidence is in the prepubertal period.

Prevalence

• Represents ~2% of patients presenting to dermatology clinics (2)
• ~3% of children using inhalational steroids develop some form of POD (3).

Etiology and Pathophysiology

• Exposure to an irritant results in breakdown of the epidermal barrier and subsequent water loss and sensation of dryness; this encourages use of facial products and corticosteroids, which may worsen the condition.
• This inflammatory cycle eventually leads to clinical features of the disease.
• The exact cause is unknown, and there may be more than one contributing factor.
• The most widely cited factor implicated in POD is use of potent topical corticosteroids on the face.
• Inhaled corticosteroids, especially when used with a spacer and nebulizer or mask, have also been reported to cause POD.
• Intranasal steroids have been associated with POD beginning in the nasolabial folds.
• Two cases associated with systemic steroid use have been reported in children (4).
• Use of foundation, moisturizer, and night cream was associated with a 13-fold increased risk of POD in one study.
• Other factors are implicated but not proven:
  • Drugs: oral contraceptives, growth hormone
  • Toothpastes: fluoridated, tartar control, whitening
  • Physical factors: UV light, heat, wind, salivary leakage
  • Infectious factors: fusiform bacteria, Candida species, Demodex folliculorum
  • Miscellaneous factors: atopy, GI disturbances, stress, contact allergy, lip licking, immunosuppression, bubble gum, formaldehyde, varicella vaccination

Genetics
55% of pediatric patients with POD have a family history of atopy.

Risk Factors

See “Etiology and Pathophysiology.”

General Prevention

• Avoid using potent topical corticosteroids on the face.
• Avoid using excessive foundation, moisturizer, and night cream.
• Avoidance of tartar-control and whitening toothpastes may also be helpful.

Commonly Associated Conditions

Atopic dermatitis