Oral Rose - Perioral Dermatitis

Oral rose (perioral dermatitis)

Perioral dermatitis (POD, also called rose in the mouth) is a chronic inflammatory skin disease that occurs in flares and mainly develops around the mouth (perioral). However, the nose (perinasal) or eyes (periocular) can also be affected. This skin disease is characterized by reddening, papules and pustules. How severe the symptoms are varies from person to person. Mostly women between the ages of 15 and 45 are affected…

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Causes & Symptoms

The exact causes for the appearance of an oral rose are unclear. It usually arises from the excessive use of cosmetic products. Therefore one often speaks of "stewardess sickness".

Over-cared for skin

Excessive use of cosmetic products can disrupt the natural barrier function of the skin and lead to the skin becoming over-moisturized and causing the horny layer to swell. This in turn increases the loss of moisture and unpleasant feelings of tension and dryness are increased. This often causes those affected to make more use of cosmetic products such as moisturizers. However, this further irritates the skin. A vicious circle arises in which the constant overeating damages the skin more and more. In the further course, inflammations can develop, which ultimately lead to the symptoms of perioral dermatitis.

Other possible factors

The following are also assumed to be the triggering factors for rose in the mouth:

• External corticosteroids (e.g., cortisone)
• stress
• Hormonal imbalances
• Intense sunlight or artificial UV light

Those affected usually complain of a dry, burning or tight skin feeling. The diseased areas on the face are often reddened, occasionally itchy and often have little flaking. In addition, typical symptoms are small, reddish papules and sometimes also inflammatory pus vesicles (pustules) on the face.

Note Although perioral dermatitis is a harmless, non-contagious skin disease, it is often perceived as aesthetically disturbing and can be a great psychological burden for those affected.

Diagnosis & Therapy

The clinical picture usually enables a quick visual diagnosis. First of all, the doctor will ask various questions as part of the anamnesis, such as:

• How long have you had the rash?
• Which cosmetic products do you use?
• Are you known to have contact allergies?

Note Perioral dermatitis must be differentiated from various clinical pictures that could also be behind the vesicles and nodules. These include, for example, rosacea, acne, contact allergies or other forms of eczema (e.g. seborrheic eczema).

The therapy varies from person to person and depends on both the severity and the level of suffering. Various therapies are available for the treatment of oral rose:

• Zero therapy: In the case of a mild form of perioral dermatitis, so-called zero therapy - all previously used cosmetics for the face are discontinued - can lead to improvement or healing.
• Local treatment with creams or ointments (topical therapy): In contrast to rosacea, in which metronidazole and azelaic acid are the topical active ingredients of first choice, there is no “gold standard” of topical therapy for perioral dermatitis, as the effectiveness of some active ingredients is insufficient is proven in studies.

Note Antibiotics can also help the perioral dermatitis resolve. In mild to moderate cases, they are applied directly to the skin.

Treatment with medication in tablet form (systemic therapy): Perioral dermatitis rarely requires systemic therapy (mostly antibiotics) and is only necessary in exceptional cases, when the local treatment has not been sufficiently effective

Cortisone aggravated

Glucocorticosteroids applied to the skin, such as cortisone, increase the skin's barrier disruption. Therefore, patients with rose mouth should not use any preparations containing cortisone. In the presence of perioal dermatitis, topical glucocorticosteriods only briefly lead to a minimal improvement, but then - due to the habituation effect and further disruption of the microenvironment - to a deterioration.

Whom can I ask?

You can contact the following doctors to diagnose and treat an oral rose:

• Specialist in dermatology
• General practitioner

How are the costs going to be covered?

Medicines and special magistral preparations on medical prescription are paid for by the social security agencies. You can find out more about the respective provisions from your health insurance provider, which you can find on the social security website.