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| Fig. 50.5 Perioral dermatitis (steroid rosacea). A, A prepubertal child with typical perioral dermatitis. B, A prepubertal child with perioral dermatitis and steroid vasoconstriction related to a midpotency topical steroid. (Courtesy of William L. Weston, MD.) |
Periorificial dermatitis is frequently associated with the inappropriate use of topical steroids (Fig. 50-5). It occurs most commonly in adult, fair-skinned caucasian women who have a family history of rosacea. The rash is characterized by inflammatory follicular papules and pustules with a background of erythema and scaling located on the chin, perioral, and perinasal skin, and less commonly on the eyelids. Most patients respond well to discontinuation of the topical steroid and oral antibiotics of the tetracycline class for 4 to 6 weeks. Some patients flare when the steroid is discontinued, and some have recurrences.
