Idiopathic dermatitis of the face

Periodic dermatitis (periorificial dermatitis, syn: idiopathic face dermatitis, steroid face dermatitis, stewardess disease, rosacea perioral, rosace-like dermatitis, photosensitive seborrhea) is a disease that affects exclusively the skin of the face and manifests itself as persistent erythema, most often developing in the perioral region, and emerging on its background with small papules and papulopustules.

A characteristic of the disease is expressed resistance to traditional external anti-inflammatory drugs. The disease is more likely in women aged 20 to 40 years, more often with the I-II skin phototype by Fitspatrick.

[1], [2], [3], [4], [5]

Causes of Idiopathic Face Dermatitis

The etiology and pathogenesis of the disease remain unclear. Traditionally, due to the common location of the rashes and the similarity of the clinical picture, the disease is referred to the so-called rosace-like dermatitis group. 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 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 glucocorticosteroid preparations 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 - "flight attendant illness". Long and erratic application of topical glucocorticosteroids causes dystrophic changes in the epidermis and dermis due to the "genomic" effect of these drugs and, in addition, leads to the dissociation of resident microflora. Theories linking the occurrence of perioral dermatitis with a microbial factor have not received sufficient evidence. In addition to external glucocorticosteroids, provocative factors include waterproof decorative cosmetics, fluorine-containing toothpastes, desired gum, insolation, oral contraceptives. However, the incidence of the disease due to these factors is different, and the association of perioral dermatitis with them is often not convincing.

[6], [7], [8]

Symptoms of idiopathic face dermatitis

The clinical picture is very typical and the differential diagnosis with rosacea is usually not difficult. The disease is more common in a younger age group than rosacea. Skin lesion usually develops rapidly, is localized and symmetrical, is represented by non-focal non-follicular, hemispherical pink-red lenticular papules (1-2 mm in diameter) and typical waxy semi-transparent amygrobic pustules and papulopustules against a background of mild erythema. Often the skin process accompanies a burning sensation. Unlike rosacea, erythema with perioral dermatitis has no tendency to increase with hot flushes; its course is monotonously virtually unrelated to the appearance of telangiectasias. Papules with a perioral dermatitis are smaller, often grouped, forming lesions, covered with whitish scales. The perioral region is often affected, in this case the red border of the lips is surrounded by a narrow rim of apparently unaffected skin. Less often there is an isolated symmetric blepharitis or a combined lesion of the periorbital and periorbital regions.

Pathomorphological changes are nonspecific and change with the course of the disease. At the onset of the disease, the development of moderately expressed follicular and perifollicular infiltrates is more diverse than the cellular composition. Characteristic is the absence of polymorphonuclear leukocytes in them. In the epidermis, there are signs of spongiosome, which is associated with the formation of cavity elements with sterile contents, with a long course characterized by the formation of perivascular lymphocytic infiltrates in the dermis.

Inadequate external therapy can lead to the formation of not large granulomas by the type of reaction to foreign bodies.

Treatment of idiopathic dermatitis of the face

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

Peripheral dermatitis usually responds well to the therapy used in rosacea. It is necessary to organize adequate gentle skin care. It is possible to use both the means recommended by the patients for the so-called "couperose", and the series of preparations for the highly sensitive skin. External preparations of azelaic acid, clindamycin, metronidazole demonstrated significant efficacy 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, especially effective for long-term papular eruptions in the absence of severe erythema, also remain relevant. Preparations for external use containing pimecrolimus are increasingly gaining attention with their effectiveness in perioral dermatitis and are regarded as an alternative to contraindicated glucocorticosteroid agents. Similarly to the therapy of rosacea, systemic measures for perioral dermatitis play an auxiliary role. First of all, efforts must be made to form a trusting relationship between the patient and the doctor. The patient should be warned about a possible exacerbation of the skin process after corticosteroid withdrawal. Considering the high cosmetic significance of the skin process, anxiolytic drugs, individual psychotherapy are often shown. The use of modern physiotherapeutic methods of treatment reduces the course of the disease, reduces the severity of secondary dyschromia. Microcurrent therapy is one such technique. This unique in its high consumer qualities has a combined effect on the face. Electric currents of small force and low frequency stimulate the restoration of microcirculation, normalize the distribution of fluid and strengthen the lymph drainage in the affected skin. Observed after the procedure, local anemia has, in addition, an important psychotherapeutic value. The courses of microcurrent therapy lead to a gradual recovery of normal trophism, a rapid resolution of the edema and contribute to an early repair of tissues.