Perioral dermatitis in children is a chronic inflammatory facial dermatosis characterized by erythematous papules and pustules around the mouth.
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Early recognition and appropriate management are essential to prevent persistence, recurrence, and unnecessary treatments.
✅ Etiology and Pathophysiology
The exact cause of perioral dermatitis remains unclear; however, several contributing factors have been identified:
▪️ Topical corticosteroid use, the most significant risk factor
▪️ Prolonged use of fluoridated toothpaste (controversial but reported)
▪️ Skin barrier dysfunction
▪️ Microbial factors (e.g., Cutibacterium acnes, Demodex species)
▪️ Use of occlusive facial products
👉 Topical steroid overuse is strongly associated with pediatric perioral dermatitis.
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Typical characteristics include:
▪️ Small erythematous papules or pustules
▪️ Distribution around the mouth, nose, and sometimes eyes
▪️ Sparing of the vermilion border
▪️ Mild burning or itching
▪️ Absence of comedones (unlike acne)
Lesions may worsen temporarily after corticosteroid withdrawal, a phenomenon known as rebound dermatitis.
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➤ Discontinuation of Triggers
▪️ Gradual withdrawal of topical corticosteroids
▪️ Avoidance of irritating cosmetics and facial products
➤ Topical Therapies
▪️ Topical metronidazole
▪️ Erythromycin or clindamycin gels
▪️ Calcineurin inhibitors (tacrolimus, pimecrolimus) in selected cases
➤ Systemic Therapy
▪️ Reserved for moderate to severe cases
▪️ Oral macrolides (e.g., erythromycin) are preferred in children
👉 Antibiotics are used for their anti-inflammatory effects rather than antimicrobial action.
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▪️ Avoid unnecessary use of topical steroids on the face
▪️ Use mild, fragrance-free facial cleansers
▪️ Educate caregivers on appropriate dermatologic treatments
▪️ Monitor fluoride toothpaste use without eliminating its caries-preventive benefit
▪️ Maintain good oral and perioral hygiene
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For pediatric dentists, perioral dermatitis may:
▪️ Mimic allergic contact dermatitis or angular cheilitis
▪️ Be exacerbated by saliva pooling or lip licking
▪️ Require coordination with dermatologists for optimal care
Dentists play a key role in early detection and referral.
📊 Comparative Table: Differential Diagnosis of Perioral Dermatitis in Children
| Aspect | Advantages | Limitations |
|---|---|---|
| Perioral Dermatitis | Papules around mouth with vermilion border sparing | May worsen after steroid withdrawal |
| Atopic Dermatitis | History of atopy, pruritus, diffuse facial involvement | No clear perioral sparing, chronic relapsing course |
| Allergic Contact Dermatitis | Clear exposure history, acute onset | Often vesicular and intensely pruritic |
| Acne Vulgaris | Presence of comedones, adolescent onset | Rare in young children, different lesion morphology |
| Angular Cheilitis | Localized to mouth corners | Does not involve perioral skin diffusely |
Perioral dermatitis in children is a benign but often persistent condition that can be misdiagnosed or mistreated. The frequent use of topical corticosteroids, sometimes prescribed for other facial rashes, contributes significantly to disease chronicity.
From a dental perspective, understanding this condition helps avoid misinterpretation of perioral lesions and prevents unnecessary dental interventions.
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▪️ Avoid prescribing topical steroids near the mouth
▪️ Educate parents about correct facial skincare
▪️ Refer to dermatology when lesions persist
▪️ Reinforce gentle oral hygiene practices
▪️ Monitor lesion progression during dental follow-ups
✍️ Conclusion
Perioral dermatitis in children is a manageable condition when properly diagnosed and treated. Early withdrawal of triggering agents, appropriate topical therapy, and preventive education lead to favorable outcomes. Pediatric dentists should be familiar with its presentation to ensure accurate diagnosis, timely referral, and comprehensive patient care.
📚 References
✔ Boeck, K., Abeck, D., & Ring, J. (2007). Perioral dermatitis in children. Journal of the American Academy of Dermatology, 57(4), 654–658.
✔ Dhar, S., Banerjee, R., & Malakar, R. (2014). Perioral dermatitis in children: An update. Indian Journal of Dermatology, 59(1), 1–6.
✔ Katsarou, A., & Armenaka, M. (2011). Perioral dermatitis. Clinical Dermatology, 29(5), 504–509.
✔ Wollenberg, A., et al. (2018). European guideline on perioral dermatitis. Journal of the European Academy of Dermatology and Venereology, 32(3), 424–433.
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