Q:When is acne not acne? A: When it’s perioral dermatitis

I’ve had a cluster of patients presenting with a troublesome facial eruption that’s been mislabelled and thought I’d blog about it because it’s very pleasing to sort and responds rapidly to correct treatment – woo-hoo!

So the common scenario is a female (like melasma, only about 10% of sufferers are men) who has spots near the mouth – within the nose-to-mouth creases and around the chin.

This has a very classic appearance – lots of tiny bumps that look the same, often joining up – but they tend to spare the skin directly next to the lip edge. The skin may be dry and flakey. The bumps on the chin are what tend to lead to the misdiagnosis of acne, as it bears similarity to the distribution of adult female-pattern acne. It can also appear around the eyes (and is then termed periorificial dermatitis) and if severe, spread onto the cheeks. Importantly, clogged pores or comedones are not a feature; this is one of the key features that distinguishes it from acne.

No-one really knows what causes this annoying problem – but the ‘wrong’ type of skin care aggravates it and topical steroids, especially the stronger variants are a common trigger.

When someone presents with this, the first thing I do is to suspend the current skincare regime (and frequently impose a make-up cull). A non-comedogenic regime is the order of the day (I know…I sound like a broken record). We have an excellent choice of soothing, non-clogging products to choose from, courtesy of French pharmacy brands like Bioderma and La Roche Posay and sometimes this will be enough to solve the problem. If topical steroids are the cause, occasionally things get worse before they get better, but stopping them is essential so stick at it.

More severe cases will benefit from prescription medication – my preferred approach is topical (azelaic acid 15-20%) and oral tetracyclines. Usually treatment for 6-8 weeks will sort things out. So satisfying.

A good skin care regime to try if you suffer from perioral dermatitis is as follows  :

Cleanse : La Roche Posay Physiological Cleansing Gel (one of my all-time favourites, non-foaming but effective at removing make-up)

Treatment product – if using a prescription product like Finacea (15% azelaic acid) apply it now, to clean skin morning and night.

Moisturise : Bioderma Sebium Hydra ( a lightweight non-clogging moisturiser for oily skin that’s dry or irritated)

Protect : Obagi Nu Derm Sunshield SPF 50 (lightweight matte finish, excellent physical block without the whitish cast)

Image : courtesy of http://www.drumd.com/

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