Periorificial dermatitis

Periorificial dermatitis (POD) is a chronic inflammatory skin condition, characterized by eruptions around the body’s orifices. Here’s a breakdown of what it is, who it affects, its causes, clinical features, complications, diagnosis, differential diagnosis, treatment, and outcome:

What is Periorificial Dermatitis?

• Chronic inflammatory skin condition.
• Targets areas around the eyes, nostrils, mouth, and occasionally the genitals.
• Variants include perioral, periocular, perinasal, and genital periorificial dermatitis.

Who Gets Periorificial Dermatitis?

• More common in lighter-skinned females.
• Typically affects young to middle-aged women (20–45 years) and children (7 months to 13 years).

Causes

• Exact cause unknown; suggested to involve epidermal dysfunction.
• Risk factors: steroid use, cosmetic use, nutritional deficiencies, occlusive emollient use, sunscreen use, exposure to allergens/irritants, hormonal changes, atopic predisposition, and physical factors like UV light.

Clinical Features

• Acneiform eruption with clusters of small, skin-coloured to red papules.
• Erythematous base, dry, scaly skin, with sensations of burning or tightness.
• Usually spares the immediate peri-vermillion skin.

Complications

• Granulomatous periorificial dermatitis, steroid rosacea, rebound flare upon cessation of topical steroids, and psychological distress.

Diagnosis

• Primarily clinical.
• May involve swabs, skin scrapings, patch testing, and biopsy for uncertain cases.

Differential Diagnosis

• Includes rosacea, acne, seborrheic dermatitis, contact dermatitis, lip licker’s dermatitis, impetigo, granulomatous rosacea, sarcoidosis, and lupus miliaris disseminatus faciei.

Treatment

• General measures include the “zero-therapy” approach: stopping all facial cosmetics and topical products.
• Specific treatments can be topical (metronidazole, erythromycin, pimecrolimus) or systemic (tetracycline, erythromycin, azithromycin).
• The POD Severity Index (PODSI) may guide treatment efficacy and severity assessment.

Outcome

• Without treatment, it can last months to years but typically does not scar.
• Most patients respond well to treatment, with the possibility of recurrence.