Periorificial Dermatitis (POD)

Definition and Characteristics:

• Nature: Chronic inflammatory skin condition.
• Target Areas: Predominantly affects areas around the eyes, nostrils, mouth, and occasionally genitals.
• Subtypes:
  • Perioral dermatitis: Primarily around the mouth.
  • Periocular dermatitis: Around the eyes.
  • Perinasal dermatitis: Around the nostrils.
  • Genital periorificial dermatitis: Affects labia majora, scrotum, or anus.

Prevalence and Demographics:

• Common Among: Lighter-skinned females, particularly young to middle-aged women (20–45 years), and also seen in children (7 months to 13 years).
• Incidence/Prevalence: Exact figures unknown.

Etiology and Risk Factors:

• Cause: Not fully understood; epidermal dysfunction is a suggested mechanism.
• Contributing Factors:
  • Steroid use (topical, inhaled, nasal).
  • Usage of cosmetics.
  • Nutritional deficiencies, especially zinc.
  • Overhydration from occlusive emollients (e.g., paraffin).
  • Physical sunscreens in children.
  • Exposure to allergens and irritants.
  • Infections from organisms like Demodex spp., Candida albicans.
  • Hormonal changes (oral contraceptives, pregnancy, menstrual cycle).
  • Atopic predisposition.
  • Environmental factors (UV light, heat, wind).

Clinical Presentation:

• Symptoms: Erythematous base, clusters of small papules, vesicles, pustules, often less than 2mm; scaly, flaky skin; burning sensation, skin tightness, itch. Pain is rare.
• Distribution: Mainly localized to affected orifices but can extend to chin, cheeks, lower and upper eyelids, forehead, glabella. Immediate peri-vermillion skin usually spared.
• Subtypes:
  • Lupoid Perioral Dermatitis: Severe form with larger, denser red-brown papules; can cause scarring.
  • Childhood Granulomatous Perioral Dermatitis (CGPD): Occurs in children, presenting with dome-shaped papules; less erythema and scaling compared to classic POD.

Complications:

• Granulomatous POD: Persistent yellowish papules, often following corticosteroid use.
• Steroid Rosacea: Caused by steroids, characterized by facial papules, papulopustules, and telangiectasia.
• Rebound Flare: Severe dermatitis following abrupt cessation of topical steroids.
• Psychological Impact: Distress related to appearance.

Diagnosis:

• Approach: Primarily based on clinical presentation.
• Additional Tests: Swabs, scrapings for bacterial/fungal infections; patch testing for allergies; biopsy for uncertain cases.

Differential Diagnosis:

• Facial POD: Differentiated from rosacea, acne, seborrheic dermatitis, contact dermatitis, impetigo.
• CGPD: Differentiated from granulomatous rosacea, sarcoidosis, lupus miliaris disseminatus faciei.

Treatment Approaches:

• General Measures: Ceasing all facial cosmetics, topical products; gentle face washing; avoiding occlusive creams.
• Topical Treatments: Metronidazole, erythromycin, pimecrolimus, and alternatives like azelaic acid, clindamycin.
• Systemic Treatments: Tetracycline (first-line), erythromycin (for pregnant women, children), azithromycin; isotretinoin for refractory cases.

Outcome and Prognosis:

• Course of Disease: Chronic and variable, lasting months to years without treatment. Usually, no scarring or pigmentation issues except in severe cases.
• Response to Treatment: Generally positive, but recurrence is possible.

This comprehensive summary provides an in-depth look into the nature, prevalence, etiology, clinical presentation, complications, diagnosis, differential diagnosis, treatment approaches, and outcomes associated with Periorificial Dermatitis.