Perioral dermatitis is a skin disorder that resembles acne or rosacea that mainly affects women aged 20 to 45. However, all age groups, including men, can develop perioral dermatitis.

WHAT ARE THE SYMPTOMS OF PERIORAL DERMATITIS?

In most cases, perioral dermatitis presents with papules (small lumps with defined edges) that are located around the mouth or in the folds of the nose and may spread to larger areas.

The papules may show at the highest part vesicles filled with fluid or pus. Around the papules the skin is red and, in some cases, scaly. In addition, there is a feeling of tightness, more rarely also burning or itching sensation. In the worst case, the eyelids, nose, forehead and even the entire face, sides of the neck and the skin behind the ears can be affected.

Papules develop in the area of the hair follicles of fine, short and poorly pigmented hair that covers much of the body surface until puberty. Some of this hair transforms into adult body hair in the course of physical development. Sometimes it can be seen that a narrow strip around the lips is free of symptoms; This is because that area has no hair.

The disease usually has a chronic course with an intermittent worsening of symptoms. Improvement to complete remission can be achieved if triggers are avoided.

WHAT CAUSES PERIORAL DERMATITIS?

The exact mechanism by which perioral dermatitis develops has not yet been clarified. However, skin flora or microbiome and natural barrier function are known to be altered as disease develops. As a result, the skin is less able to retain moisture, becomes drier and tighter. Redness and scaly areas appear. Harmful substances from the environment and infectious agents can more easily penetrate the skin.

In addition to a damaged skin barrier and altered skin flora, dysregulation of the skin’s immune system is also an important aspect in the development of the disease. The aforementioned processes influence each other and can be triggered by the causes listed in the following section.

The symptoms are the result of a combination of these processes. Damaged skin tries to repair its surface and the immune system is activated by exposure to microorganisms and toxic agents, which increases inflammation.

WHAT ARE THE CAUSES OF PERIORAL DERMATITIS?

Various exogenous (from outside) and endogenous (from the body itself) factors that can lead to the development of pathology are discussed. In each patient a combination of causes can occur that contributes to the development of the disease.

Exogenous causes:

• Excessive use of cosmetic products and therefore an “over care” of the skin.
• Use of inappropriate and harmful cosmetic products.
• Local or systemic application of glucocorticoids (cortisone).
• Intensive exposure to solar or artificial ultraviolet radiation.
• Wear a mask for a long time.

Endogenous causes:

• Genetic factors.
• Diseases of the gastrointestinal tract.
• Hormonal imbalances.
• Stress.

EXCESSIVE SKIN CARE

Excessive cosmetic treatments – moisturizers, anti-wrinkle creams, peels, masks, etc. – can have unforeseen effects. The skin has its own balance, which can be altered by the different products with which we try to take care of it or improve its appearance. For example, moisturizers can inflame the stratum corneum and interfere with its natural function.

Daily facial cleansing can also damage the skin. Surfactant detergents can damage the skin barrier in many ways:

• The fats that lie between the cells of the stratum corneum can separate.
• There may be an interaction between surfactants and keratin (structural skin protein), which in turn can cause cell membranes to swell and eventually destroy skin cells.
• Collagen fibers and other skin proteins are damaged.
• The process of differentiation of stratum corneum cells may be disrupted.

As a result, the skin is less able to retain moisture, dries out and becomes tight. Then the person uses other products with the intention of helping the skin, but which lead to further deterioration. A vicious cycle occurs and the skin can acquire a generalized hypersensitivity to a large number of cosmetic ingredients.

HARMFUL COSMETIC PRODUCTS

Cosmetic products contain numerous substances that can damage the skin and contribute to irritation. This could also be a causal factor for the development of perioral dermatitis or to aggravate an existing clinical picture. These substances include, for example:

• Perfumes
• Some surfactants
• Alcohols
• Certain preservatives
• Mineral oils and other ingredients

The surfactants of some cleansers, in addition to the effects described above, favor a change in the natural slightly acidic pH of the skin. This disrupts the skin’s defense function and makes it more susceptible to harmful microorganisms.

Alcohols are also found in many cosmetic products. They lead to degreasing of the skin and therefore to increased moisture loss. They also interfere with the skin’s natural microflora.

Polyethylene glycols (PEGs) also affect the barrier function of the skin and increase its vulnerability.

GLUCOCORTICOIDS

Glucocorticoids are found naturally in the body, but are produced synthetically (e.g., prednisolone, dexamethasone) for use as anti-inflammatory and immunosuppressive drugs.

However, in the case of perioral dermatitis, the use of preparations containing glucocorticoids (for example, hydrocortisone ointment) on the face is prohibited, because they damage the skin barrier through various mechanisms and lead to a long-term worsening of symptoms.

Long-term use of an ointment containing cortisone (to treat dermatitis, for example) can also trigger perioral dermatitis. Even the use of cortisone in spray form (for example, for asthma) or in pills can trigger oral erysipelas.

ULTRAVIOLET (UV) RADIATION

Excessive skin exposure to UV radiation damages the skin and can exacerbate inflammatory diseases such as perioral dermatitis or rosacea. Consequently, intense sunlight should be avoided as much as possible and visits to the solarium altogether.

Since using sunscreen can also exacerbate perioral dermatitis, the only way to avoid UV radiation during the acute phase of the disease is to stay in the shade.

MASK

Mouth and nose masks can also lead to the development of perioral dermatitis. Because the warm, moist exhaled air is retained under the protective mask, the layer of skin swells and the skin barrier is broken. In this hot and humid environment, the proliferation of microorganisms is favored and the affected skin is easily inflamed.

In addition, the mechanical stimulus when wearing the mask causes constant irritation of the skin. Fragrances or other chemicals contained in masks can also have a negative effect on skin health. Other skin diseases such as acne, rosacea and oral erysipelas can be aggravated by frequent use of a protective mask.

GENETIC FACTORS

Genetic factors play a role in a variety of diseases. It has been shown that patients with perioral dermatitis often have the so-called atopic diathesis or atopy, a genetic predisposition to the development of IgE-mediated (allergic) hypersensitivity reactions.

In addition to perioral dermatitis, these reactions may also include bronchial asthma and atopic dermatitis (neurodermatitis). Dry skin is also more common in patients with a predisposition to atopy.

DISEASES OF THE GASTROINTESTINAL TRACT

A current research topic is the connection between the gut microbiome (gut flora), the skin microbiota (skin flora) and the development of skin diseases. The connection between the gut and the skin is also known as the “gut-skin axis” or the “gut-gut-skin microbiota axis”.

The microbiota is involved in the regulation of the immune system and it is known that in many skin diseases there is dysbiosis (disorder of the composition of the cutaneous and intestinal floras. The exact mechanisms of how gut bacteria affect those on the skin have yet to be clarified in detail.

HORMONAL IMBALANCES

Hormonal influences are also discussed as possible triggers of perioral dermatitis. This is supported by the fact that most patients are women and many also report worsening of symptoms in relation to their period. In addition, taking hormonal contraceptives could also have an impact on the development of the disease.

STRESS

It is well known that stress leads to a suppression of the immune system and puts pressure on the entire body in a variety of ways. For example, high levels of stress can worsen skin conditions, such as perioral dermatitis.

On the one hand, stress hormones and other messenger substances that are released during stress have a direct impact on the skin. On the other hand, stress has a negative effect on the intestinal flora.

HOW TO NATURALLY TREAT PERIORAL DERMATITIS?

When perioral dermatitis is diagnosed, the first and often decisive step in therapy is to completely discontinue the application of all hygiene and cosmetic products used in the previous weeks.

If preparations containing corticosteroids on the skin were used, these are also discontinued. Facial cleansing should be done very carefully. The ideal is a gentle cleansing of the face with water and careful patting drying.

Rubbing the skin with a towel should be avoided, as mechanical irritation can also worsen symptoms. If necessary, the face can be washed once a day, ideally at night, with a gentle, pH-neutral skincare product.

Many people who suffer from perioral dermatitis have a hard time resisting applying products. In that case, at most a high-quality aloe vera gel could be applied.

A proven home remedy for severe irritation and feeling of tightness are compresses with cold black tea, which should be allowed to stand for at least 5-10 minutes so that the water contains a sufficient number of tannins. Then a cloth soaked with the cooled tea should be placed over the affected skin areas for several minutes.

HEALTHY DIET IN PERIORAL DERMATITIS

With a healthy diet we can positively influence the intestinal microbiota and the evolution of perioral dermatitis. You can follow the following principles:

• Try to eat organic foods.
• Includes prebiotic foods (such as onions, leeks, oats, almonds)
• Make sure you have enough omega-3 fatty acids (walnuts, flaxseeds and chia seeds or their oils).
• Follow a diet low in salt and saturated fat.
• Waiver of ultra-processed persons.

WHAT ARE THE CHANCES OF RECOVERY FROM PERIORAL DERMATITIS?

In many cases, reducing and changing skin care for perioral dermatitis leads to significant improvement or healing of symptoms. If other possible causes are also treated or reduced, such as dysbiosis of the intestinal flora or high levels of stress, a permanent absence of symptoms can be achieved.

However, since there is often a genetic predisposition, it should always be noted that perioral dermatitis may recur.

Scientific references:

• Fercek I et al. Features of the skin Microbiota in Common Inflammatory Skin Disease. Life.
• Mahmud MR et al. Impact of gut microbiome on skin health: gut skin axis observed through the lenses of therapeutics and skin disease. Gut Microbes.
• De Pessemier B et al. Gut-Skin Axis: Current Knowledge of the Interrelationship between Microbial Dysbiosis and Skin Conditions. Microorganisms.
• M. Tlaymat L and Hall MR. Perioral Dermatitis. Stat Pearls (internet).

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