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Bilateral (almost symmetric) discrete erythema (redness), accompanied with dryness and papules (small “bumps”) in perioral and perinasal region is most likely Periorificial dermatitis. Potential differential diagnoses include Acne rosacea, Seborrhoic dermatitis, Contact dermatitis, Lip-licking dermatitis, etc.
The main thing to know about Periorificial (perioral) dermatitis is that it can be caused, and is always aggravated, by the use of topical corticosteroids. So, use of corticosteroids is contraindicated.
Also important, and quite encouraging, is the fact that perioral dermatitis is mostly a self-limiting disease that evolves during several weeks and resolves over several months, rarely longer.
In regards to treatment, first line of therapy would be topical metronidazole concurrently with oral tetracycline, or doxycycline or minocycline for 2,5 – 3 months. Systemic erythromycin is recommended in children, pregnant and nursing mothers and tetracycline-allergic patients. Second line of topical therapy could be erythromycin, clindamycin, azalaic acid or sulfur preparations.
In addition, it is recommended to reduce use of cosmetics and make-up and avoid introduction of new skin care and oral care products. The goal is not to irritate skin, trigger allergic reaction or simply prevent further damage of skin barrier function and consequent dryness and sensitivity.
Wishing You Optimal Health,
Dr. Jasmina Jankicevic
I have the exact same thing on my face and as soon as a I a couple days break from the scaly bumpy rash it comes right back again. It is embarrassing