Idiopathic facial dermatitis

Perioral dermatitis (periorificial dermatitis, syn.: idiopathic dermatitis of the face, steroid dermatitis of the face, flight attendant disease, perioral rosacea, rosacea-like dermatitis, photosensitive seborrhea) is a disease that affects exclusively the skin of the face and is manifested by persistent erythema, most often developing in the perioral area, and small papules and papulopustules that appear against its background.

The disease is characterized by pronounced resistance to traditional external anti-inflammatory agents. Women aged 20 to 40 years are more susceptible to the disease, more often with I-II skin phototype according to Fitspatrick.

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Causes of idiopathic facial dermatitis

The etiology and pathogenesis of the disease remain unclear. Traditionally, due to the common localization of the rashes and the similarity of the clinical picture, the disease is classified as a so-called group of rosacea-like dermatitis. However, perioral dermatitis is not accompanied by such pronounced changes in vascular reactivity as rosacea, and has a slightly different histopathological and clinical picture.

The main initiating factor of perioral dermatitis is considered to be the uncontrolled use of topical fluorinated (halogenated) corticosteroids. Due to the pronounced anti-inflammatory effect, the rapid onset of the effect provokes patients to use glucocorticosteroids for any inflammatory process in the skin of the face. This is largely due to the origin of one of the names of perioral dermatitis - "stewardess disease". Long-term and indiscriminate use of topical glucocorticosteroids causes dystrophic changes in the epidermis and dermis due to the "genomic" effect of these drugs and, in addition, leads to dissociation of the resident microflora. Theories linking the occurrence of perioral dermatitis with a microbial factor have not received sufficient evidence. In addition to external glucocorticosteroids, provoking factors include waterproof decorative cosmetics, fluoride-containing toothpastes, gum, insolation, and oral contraceptives. However, the incidence of the disease in connection with these factors varies, and the connection of perioral dermatitis with them is often not convincing.

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Symptoms of idiopathic facial dermatitis

The clinical picture is quite typical and differential diagnosis with rosacea is usually not difficult. The disease is more common in a younger age group than rosacea. Skin lesions usually develop quickly, are localized and symmetrical, and are represented by non-follicular, hemispherical, pink-red lenticular papules (1-2 mm in diameter) that are not prone to merging, and typical waxy, translucent, microbial pustules and papulopustules against a background of mild erythema. The skin process is often accompanied by a burning sensation. Unlike rosacea, erythema in perioral dermatitis does not tend to increase with hot flashes, its course is monotonous and is practically not associated with the occurrence of telangiectasias. Papules in perioral dermatitis are smaller, often grouped, forming lesions covered with whitish scales. The perioral region is most often affected, in which case the red border of the lips is surrounded by a narrow rim of apparently unaffected skin. Less common is isolated symmetrical blepharitis or combined lesions of the perioral and periorbital regions.

Pathological changes are non-specific and change as the disease progresses. At the onset of the disease, moderate follicular and perifollicular infiltrates of varying cellular composition are characteristic. They are characterized by the absence of polymorphonuclear leukocytes. In the epidermis, signs of spongiosis are noted, which are associated with the formation of cystic elements with sterile contents; with a long course, perivascular lymphocytic infiltrates in the dermis are characteristic.

Inadequate external therapy can lead to the formation of small granulomas similar to a foreign body reaction.

Treatment of idiopathic facial dermatitis

Successful treatment of perioral dermatitis is impossible without eliminating the factors suspected of causing the disease. It is necessary to completely discontinue topical steroids. It is recommended to stop using fluorinated toothpastes, waterproof cosmetics, especially tinted products, chewing gum, avoid intense insolation and exposure to adverse weather conditions. Conduct examination and treatment of concomitant chronic pathology of the digestive and endocrine systems.

Perioral dermatitis usually responds well to therapy used for rosacea. Adequate gentle skin care should be organized. It is possible to use both products recommended for patients with so-called "couperose" and series of products for highly sensitive skin. External preparations of azelaic acid, clindamycin, metronidazole have demonstrated reliable effectiveness in the treatment of perioral dermatitis as well as rosacea. With bright erythema and pronounced edema of the skin, it is advisable to use lotions with cool solutions of boric acid and tannin. Sulfur preparations also remain relevant, especially effective against long-standing papular rashes in the absence of pronounced erythema. Preparations for external use containing pimecrolimus are increasingly gaining attention for their effectiveness in perioral dermatitis and are regarded as an alternative to contraindicated glucocorticosteroids. Similar to rosacea therapy, systemic measures in perioral dermatitis play a supporting role. First of all, it is necessary to make efforts to form a trusting relationship between the patient and the doctor. The patient should be warned about the possible exacerbation of the skin process after the abolition of corticosteroids. Given the high cosmetic significance of the skin process, anxiolytic drugs and individual psychotherapy are often indicated. The use of modern physiotherapeutic methods of treatment shortens the course of the disease, reduces the severity of secondary dyschromia. One of such methods is microcurrent therapy. This technique, unique in its high consumer qualities, has a combined effect on the skin of the face. Low-power and low-frequency electric currents stimulate the restoration of microcirculation, normalize fluid distribution and enhance lymph flow in the affected skin. Local anemia observed after the procedure has, among other things, an important psychotherapeutic value. Courses of microcurrent therapy lead to a gradual restoration of normal trophism, rapid resolution of edema and contribute to the fastest possible tissue reparation.