Small Pimples Around Mouth: Perioral dermatitis and Others

• If you’ve noticed small pimples around your mouth you may be wondering what’s causing them. There are a few different things that can cause this including hormonal changes allergies and even certain medications. 

• If you’re not sure what’s causing your pimples it’s best to see a dermatologist so they can help you determine the best course of treatment.

 

Perioral dermatitis

• Perioral dermatitis (POD) is an inflammatory and chronic papulopustular and vesicular dermatitis that primarily affects youngsters and middle-aged females.

• In addition to identifying the probable causes, topical or systemic therapy is frequently performed. 

• Most dermatologists are aware of its link with corticosteroid use, but less is known about other associations such as infectious, cosmetic, disrupting skin barrier, dental fillings, and toothpaste.

 

1. Symptoms

• Perioral dermatitis appears as pruritic or sensitive erythematous papules in the perioral (sparing the vermillion) and periorbital areas, with rare vaginal involvement.

 

2. Causes of Perioral dermatitis

• There is no single known cause of perioral dermatitis. However, there are a few things that may contribute to the development of the condition.

 

1. Corticosteroids 

• Chronic use of topical, nasal, inhaled, and oral corticosteroids has been linked to Perioral dermatitis. 

• Perioral dermatitis is frequently successfully treated with topical steroids at first, but relapse occurs with corticosteroid removal.

• Topical steroids may change the microbiota of hair follicles, resulting in a microflora imbalance that contributes to Perioral dermatitis.

 

2. Infections

• Perioral dermatitis has been linked to infectious by some researchers.

• Fusobacteria, Demodex folliculorum, and Candida albicans are possibly involved in the pathogenesis of perioral dermatitis.

 

3. Sunscreens, Cosmetics, and Moisturizers

• The relationship between cosmetics, moisturizers, sunscreens, and POD was examined. Experts believe that POD was caused by an occlusive mechanism.

 

4. Skin Barrier Dysfunc Tion and Allergy

• Perioral dermatitis patients are considered to be "hyper-reactive," with poor skin barriers, particularly in the perioral area.

 

3. Treatment Of Perioral Dermatitis

• There are many different treatments for perioral dermatitis including over-the-counter creams, ointments prescriptions, and medications. Treatments are chosen based on the severity of symptoms, the treatments that have already been tried, and the patient's personality.

• Topical treatment efficacy is evaluated after 3 weeks. Systemic therapies should be used for no longer than 8 weeks.

 

1. First line treatment

• In terms of topical treatments, treatment abstinence is an alternative.

•  If this strategy is unsuccessful, patients may be given topical antibiotics (metronidazole or erythromycin) or pimecrolimus.

 

2. Systemic medications

• Systemic medications should be avoided in first-line therapy a positive response is usually obtained quickly when steroid creams or cosmetics are stopped or when topical treatments are prescribed.

• Systemic medication should be reserved for instances that are resistant to topical therapies.

• Tetracycline or one of its derivatives is the therapy of choice if systemic treatment is required. 

• Erythromycin should only be used in pediatric cases of the disease or when tetracyclines are contraindicated. 

• The use of retinoids is an intriguing treatment option for granulomatous forms of the disease.

 

Other Causes of Small Pimples Around Mouth

• Steroid-induced rosacea, lupus miliaris of the face, and acne should be ruled out because they can have a similar distribution to POD.

 

1. Rosacea

• Rosacea typically has a centrofacial distribution with no comedones and, in certain cases, rhinophyma or ocular symptoms, which are uncommon in POD. 

 

2. Lupus miliaris disseminatus faciei

• Red-brown papules and nodules, as well as atrophic tiny scars, are seen in lupus miliaris disseminatus faciei, with spontaneous regression.

 

3. Acne vulgaris

• Acne vulgaris is distinguished by the presence of comedones, papules, pustules, nodules, and cysts, which are not typical of POD. 

 

4. Sarcoidosis

• Sarcoidosis can also appear with red-brown papules on the periorificial parts of the face, comparable to perioral dermatitis. Sarcoidosis can also appear with red-brown papules on the periorificial parts of the face, comparable to perioral dermatitis.  

• Sarcoidosis lesions are typically more widespread and can occur in other areas of the skin, and patients frequently experience systemic sarcoidosis symptoms. 

• A biopsy can help differentiate sarcoidosis.

 

5. Seborrheic dermatitis

• Seborrheic dermatitis is characterized by red patches with greasy scales on the brows, glabella, paranasal skin, nasolabial folds, and chest.

 

6. Allergic contact dermatitis

• Allergic contact dermatitis is another possibility, however, it typically manifests as patches with probable lichenification. 

• If traditional therapies fail to improve perioral dermatitis, patch testing should be considered to rule out allergic contact dermatitis from skincare or oral care products.

 

7. Lip licker's cheilitis

• Lip licker's cheilitis, for example, is characterized by erythema and scaling of the cutaneous lip. 

• This often affects the vermillion lip as well as the vermillion border. Perioral dermatitis, on the other hand, spares the vermillion border.

 

Conclusion

• Perioral dermatitis has been linked to a variety of causes, including the overuse of topical or inhaled corticosteroids, infection with fusobacteria, reactions to cosmetics, dental fillings, toothpaste, and even skin barrier disorder.

• New research is needed to thoroughly evaluate promising therapeutic possibilities such as tetracyclines, topical metronidazole, topical azelaic acid, adapalene gel, and oral isotretinoin.