| 词条 | Draft:Perioral dermatitis |
| 释义 |
| name = Perioral dermatitis | synonyms = Periorificial dermatitis | field = Dermatology | symptoms = Papules pustules red skin | complications = Skin infection | causes = topical steroids cosmetics moisturiser | diagnosis = Based on symptom | differential = Rosacea, acne | treatment = None, tetracycline | frequency = }} Perioral dermatitis is a type of skin rash. Symptoms include multiple small (1–2 mm) blisters with sometimes background redness and scale, localized to the skin around the mouth and nostrils. Less commonly the eyes and genitalia may be involved.[1] It can be persistent or recurring and resembles particularly rosacea and to some extent acne and allergic dermatitis. The cause is unclear.[2] Topical steroids, moisturizers, and cosmetics may contribute. The underlying mechanism may involve blockage of the skin surface followed by subsequent excessive growth of skin flora. Fluorinated toothpaste and some micro-organisms including candida may also potentially worsen the condition, but their roles in this condition is unclear.[3] It is considered a disease of the hair follicle with biopsy samples showing microscopic changes around the hair follicle. Diagnosis is based on symptoms. Treatment is typically by stopping topical steroids which frequently, changing cosmetics, and in more severe cases, taking tetracyclines by mouth.[2][5] Stopping steroids may initially worse the rash. The condition is estimated to affect 0.5-1% of people a year in the developed world. Up to 90% of those affected are women between the ages of 16 and 45 years, though it also affects children and the elderly, has an increasing incidence in men.[6][7] Signs and symptomsA stinging and burning sensation with rash is often felt and noticed, but itching is less common.[6] Often the rash is steroid responsive, initially improving with application of topical steroid.[2] The redness caused by perioral dermatitis has been associated with variable level of depression.[10] Initially, there may be small pinpoint papule either side of the nostrils. Multiple small (1-2mm) papules and pustules then occur around the mouth, nose and sometimes cheeks. The area of skin directly adjacent to the lips, also called the vermillion border, is spared and looks normal. There may be some mild background redness and occasional scale.[1] These areas of skin are felt to be drier and therefore there is a tendency to moisturise them more frequently. Hence, they do not tolerate drying agents well and the rash can be worsened by them.[7] Perioral dermatitis is also known by other names including rosacea-like dermatoses, periorofacial dermatitis and periorificial dermatitis. Unlike rosacea which involves mainly the nose and cheeks, there is no telangiectasia in perioral dermatitis. Rosacea also has a tendency to be present in older people. Acne can be distinguished by the presence of comedones and by its wider distribution on the face and chest.[2] Other skin diseases which may resemble perioral dermatitis include:
CausesThe cause of perioral dermatitis is unclear.[1][3] The use of topical steroids and cosmetics have the most important role.[7] Although light exposure has been discounted as a causal factor, some reports of perioral dermatitis have been made by some patients receiving Psoralen and ultraviolet A therapy.[1] CorticosteroidsPerioral dermatitis often happens after the use of topical steroids on the face and is more likely the greater the strength of topical steroid used.[1] Discontinuing the steroids often initially worsens the dermatitis and dependency on the steroids can occur. Inhaled corticosteroids may also trigger perioral dermatitis.[1][3] Perioral dermatitis has a tendency to occur on the drier parts of the face and can be aggravated by drying agents including topical benzoyl peroxide, tretinoin and lotions with an alcohol base.[4] ImmunosuppressantsReports of perioral dermatitis in renal transplant recipients treated with oral corticosteroids and azathioprine have been documented.[3] CosmeticsCosmetics play an important role as causal factors for perioral dermatitis.[3] Regular generous applications of moisturising creams cause persistent hydration of the horny layer causing impairment and occlusion of the barrier function, irritation of the hair follicle and proliferation of skin flora. Combining this with night cream and foundation significantly increases risk of perioral dermatitis by 13-fold.[4][2] Micro-organismsTopical corticosteroids may lead to increase micro-organism density in the hair follicle.[1] The role of infectious agents such as Candida species, Demodex folliculorum, and fusiform bacteria has not been confirmed.[5] PsychosocialAs a significant cosmetic impairment, perioral dermatitis is increasingly documented to have psychosocial aspects to its cause and clinical findings. Specific personality structures, professions and social habits have been implicated in the type of patient the condition occurs in.[6] Other potential causesThe condition may be potentially worsened by fluorinated toothpaste and inhaled corticosteroids.[1][3] A high prevalence of atopy has been found in those suffering from perioral dermatitis.[1][5] The possibility of an association with the wearing of the veil in Arab women.[3] PathophysiologyThe pathophysiology of perioral dermatitis is related to disease of the hair follicle as is now included in the ICD-11 due to be finalised in 2018.[7] Lip lickers dermatitis, or perioral irritant contact dermatitis due to lip-licking is considered a separate disease categorised under Irritant contact dermatitis due to saliva.[8] Perioral dermatitis is frequently histologicaly similar to rosacea with the two conditions overlapping considerably.[9] There is a lymphohistiocytic infiltrate with perifollicular localization. and marked granulomatous inflammation. Occasionally, perifollicular abscesses may be present when pustules and papules are the dominant clinical findings.[6] DiagnosisA diagnosis of perioral dermatitis is typically made based on the characteristics of the rash. A skin biopsy is usually not required to make the diagnosis but can be helpful to rule out other skin diseases which may resemble perioral dermatitis. Extended patch testing maybe useful to also rule out allergic contact causes.[9] TreatmentMultiple treatment regimes are available and treatment algorithms have been proposed.[3] Perioral dermatitis will usually resolve within a few months without medication and by limiting the use of cosmetics. This is called zero treatment. Topical corticosteroids should be stopped entirely if possible.[10][11] If the flare proves intolerable, temporary use of a less potent topical corticosteroid can often be helpful.[5] MedicationA number of medications speed up recovery including: tetracycline, doxycycline, and erythromycin.[12] Erythromycin may be used as a cream.[11] Doxycycline is most often the first antibiotic drug choice, given at a daily dosage of 100mg for upto a month before considering tapering off or stopping. Sometimes, longer duration of low doses of doxycycline are required.[4] Metronidazole is less effective, is available in a gel and can be applied twice daily. If the perioral dermatitis was triggered by a topical steroid then pimecrolimus cream can be effective in improving symptoms.[4] PrognosisPerioral dermatitis is likely to fully resolve with short courses of antibiotics but if left untreated it can persist for years and take a chronic form.[1] EpidemiologyMost commonly in women between the ages of 16 and 45 years, perioral dermatitis also occurs equally in all racial and ethnic backgrounds and include children as young as three months and is increasingly reported in men. In children, females are more likely affected. It has an incidence of up to 1% in developed countries.[13] HistoryThe disorder appears to have made a sudden appearance with a case of ‘light sensitive seborrhoeid’ in 1957, which is said to be the first nearest description of the condition. By 1964, the condition in adults became popularly known as perioral dermatitis but without clear clinical criteria.[1] In 1970, the condition was recognised in children. That all rashes around the mouth are perioral dermatitis has since been frequently debated.[14] That this condition should be renamed periorificial dermatitis has been proposed.[15] Darrell Wilkinson, 1919-2009, was a British dermatologist who gave one of the earliest 'definitive' descriptions of 'perioral dermatitis' and noted that the condition was not always associated with the use of fluorinated steroid creams.[4][2][16] References1. ^1 2 3 4 5 {{Cite book|url=https://www.worldcat.org/oclc/930026561|title=Rook's textbook of dermatology|last=|first=|publisher=|others=Griffiths, C. (Christopher),, Barker, Jonathan, MD,, Bleiker, Tanya, 1969-, Chalmers, Robert (Robert J. G.), Creamer, Daniel,|year=|isbn=9781118441190|edition= Ninth |location=Chichester, West Sussex|pages=|chapter=90 and 91|oclc=930026561}} 2. ^1 2 3 {{cite book|last1=Marks|first1=Ronald|title=Facial Skin Disorders|date=2007|publisher=CRC Press|isbn=9781435626225|page=39|url=https://books.google.co.uk/books?id=YF7shfGl5r0C&pg=PA39|language=en}} 3. ^1 2 3 4 5 6 {{cite journal|last=Tempark|first=T|author2=Shwayder, TA|title=Perioral dermatitis: a review of the condition with special attention to treatment options.|journal=American Journal of Clinical Dermatology|date=Apr 2014|volume=15|issue=2|pages=101–13|pmid=24623018|doi=10.1007/s40257-014-0067-7}} 4. ^1 2 3 4 5 6 7 {{Cite book|title=Clinical Dermatology|last=Thomas P|first=Habif MD|publisher=Elsevier|year=2016|isbn=|location=|pages=218-262|chapter=Acne, rosacea, and related disorders|chapter-url=https://www-clinicalkey-com.rsm.idm.oclc.org/#!/content/book/3-s2.0-B9780323261838000163?scrollTo=%23top}} 5. ^1 2 {{Cite book|title=Treatment of Skin Disease: Comprehensive Therapeutic Strategies|last=Lebwohl|first=Mark G., MD|last2=Heymann|first2=Warren R., MD|last3=Berth-Jones|first3=John, FRCP|last4=Coulson|first4=Ian H., BSc, MB, FRCP|publisher=|year=2018|isbn=978-0-7020-6912-3|edition= 5th|location=|pages=619-620}} 6. ^{{Cite book|url=https://books.google.co.uk/books?id=NHnEMdgKJbIC&pg=PA109&dq=cosmetics+perioral+dermatitis&hl=en&sa=X&ved=0ahUKEwjGmpWOwK_XAhWDyKQKHbZfCJYQ6AEILjAB#v=onepage&q=cosmetics%20perioral%20dermatitis&f=false|title=Clinical Management in Psychodermatology|last=Harth|first=Wolfgang|last2=Gieler|first2=Uwe|last3=Kusnir|first3=Daniel|last4=Tausk|first4=Francisco A.|date=2008-11-14|publisher=Springer Science & Business Media|isbn=9783540347187|location=|pages=109|language=en}} 7. ^{{Cite web|url=https://icd.who.int/dev11/l-m/en#/http://id.who.int/icd/entity/1815308480|title=ICD-11 Beta Draft - Mortality and Morbidity Statistics|website=icd.who.int|language=en|access-date=2017-11-09}} 8. ^{{Cite web|url=https://icd.who.int/dev11/l-m/en#/http://id.who.int/icd/entity/589630386|title=ICD-11 Beta Draft - Mortality and Morbidity Statistics|website=icd.who.int|language=en|access-date=2017-11-14}} 9. ^1 2 3 4 5 {{Cite book|url=http://www.sciencedirect.com/topics/medicine-and-dentistry/perioral-dermatitis|title=Weedon's Skin Pathology|last=Patterson|first=James W|publisher=Churchill Livingstone, Elsevier|year=2016|isbn=978-0-7020-6200-1|location=|pages=189-218|chapter=Perioral Dermatitis}} 10. ^https://www.dermnetnz.org/topics/periorificial-dermatitis/ 11. ^1 2 {{cite journal|last1=Hall|first1=CS|last2=Reichenberg|first2=J|title=Evidence based review of perioral dermatitis therapy.|journal=Giornale italiano di dermatologia e venereologia : organo ufficiale, Societa italiana di dermatologia e sifilografia|date=August 2010|volume=145|issue=4|pages=433–44|pmid=20823788}} 12. ^U.S. National Library of Medicine (December 11, 2009) [https://www.nlm.nih.gov/medlineplus/ency/article/001455.htm 'Perioral dermatitis']. Retrieved August 7, 2010. 13. ^1 2 3 4 http://emedicine.medscape.com/article/1071128-overview 14. ^{{Cite journal|last=Lee|first=Grace|last2=Zirwas|first2=Matthew|date=July 2015|title=Granulomatous Rosacea and Periorificial Dermatitis|url=http://www.derm.theclinics.com/article/S0733-8635(15)00022-4/abstract|journal=Dermatologic Clinics|volume=33|pages=447-455|via=Elsevier Inc}} 15. ^1 2 3 4 5 {{Cite book|title=Fitzpatrick's Dermatology in General Medicine|last=Goldsmith|first=Lowell P.|last2=Katz|first2=Stephen I.|last3=Gilchrest|first3=Barbara A.|last4=Paller|first4=Amy S.|publisher=The McGraw-Hill Companies|year=2012|isbn=978-0-07-166904-7|edition= 8th|location=|pages=|chapter=82|chapter-url=http://accessmedicine.mhmedical.com/Content.aspx?bookId=392§ionId=41138787}} 16. ^{{Cite web|url=http://munksroll.rcplondon.ac.uk/Biography/Details/6188|title=Munks Roll Details for Peter Edward Darrell Sheldon Wilkinson|website=munksroll.rcplondon.ac.uk|access-date=2017-11-06}} |
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