Periorifical dermatitis

An 18-year-old healthy female presented with multiple grouped tiny red raised skin lesions on her face around mouth and nares for 1 month, associated with mild itching. She had a history of application of topical betamethasone valerate (0.1% w/w) cream twice daily for skin brightening, taken over the counter over her face for the past 1 year. Cutaneous examination revealed multiple, discrete, grouped erythematous papulopustular, and papulovesicular lesions, with loose fine whitish scaling and surrounding erythema on her face in perioral and perinasal distribution, with characteristic sparing of skin adjoining the vermillion border of lips [Figure 1]. Dermoscopy revealed reddish background erythema, prominent follicular openings, and superficial white and yellow scales [Figure 2]. Gram stain and potassium hydroxide mount were negative. She was diagnosed with periorificial facial dermatitis, probably initiated and exacerbated by betamethasone application. She was advised to discontinue steroid application, substituted with topical pimecrolimus 1% cream, and was prescribed oral tetracycline for 8 weeks in a tapering course, along with topical metronidazole 0.75% gel. Her skin eruption resolved with no recurrence as of yet.

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Figure 1:

Note multiple, discrete, grouped erythematous papules, with loose fine whitish scaling and surrounding erythema in perioral and perinasal distribution, with characteristic sparing of skin adjoining the vermillion border of lips.

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Figure 2:

Dermoscopy showing reddish background erythema, prominent follicular openings and superficial white and yellow scales (DermLite DL3N, dry, contact, polarized, ×10).

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