Periorificial dermatitis — SCE Dermatology MCQ

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ModerateGeneral dermatology & dermatology in primary health carePeriorificial dermatitisSCE Dermatology

A 35-year-old woman has clusters of small erythematous papules around the mouth and nose, sparing a narrow rim next to the vermilion border. She has been applying a potent topical corticosteroid to the face for 6 weeks. There are no comedones or telangiectasia. What is the most likely diagnosis?

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Correct answer: C — Periorificial dermatitis

The correct answer is C, Periorificial dermatitis. This eruption of clustered small erythematous papules (sometimes papulopustules) around the mouth and nose, with a characteristic clear zone immediately adjacent to the vermilion border, is the classic presentation of periorificial (perioral) dermatitis. It is strongly associated with prolonged use of potent topical corticosteroids on the face, as in this patient who had applied one for 6 weeks, corticosteroid withdrawal often triggers a flare or rebound of lesions. The absence of comedones and telangiectasia helps exclude the main differentials, and the perinasal and perioral clustering with sparing of the vermilion rim is a described discriminating feature of this condition. Management centres on stopping the topical steroid and using topical or oral antibiotics such as metronidazole or tetracyclines.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/skin-conditions