Perioral Dermatitis

Expert Q&A

Chronic lip licking can often cause irritation around a child's mouth.
Chronic lip licking, especially in the winter, can often cause this type of irritation around a child's mouth. Photo by Vincent Iannelli, MD

Q. My 2-year-old daughter has very fair, sensitive skin. About 6 months ago she started getting a rash on her chin. Sometimes it is very red and shiny, other times it is pale and chaffed. It doesn't seem to itch but when she eats fruit and the juices touch it, it seems to sting. It has since seemed to spread. She has several round spots on her face. The spots are raised and sort of chapped. Sometimes they will completely go away but, within a couple days, they return in the exact same spots. Michelle, Merrimack, NH

Answer. Have you been putting a steroid cream on it, such as an over-the-counter hydrocortisone cream or a stronger, prescription strength steroid cream?

Perioral Dermatitis

If so, then she may have perioral dermatitis, a chronic rash that is often caused by using steroid creams on a child's face.

In many situations, a child has a simple rash caused by irritation and is treated with a steroid cream. While that helps the rash get better for a little while, it then gets worse again and eventually doesn't respond to the steroid cream anymore.

If you are using a steroid cream and think that she may have perioral dermatitis, then you should stop using it. Be warned that the rash will get worse once you stop using the steroids and will then gradually get better. Sometimes, a topical or oral antibiotic is also needed to help perioral dermatitis go away.

Treatments for Perioral Dermatitis

Common treatments for perioral dermatitis might include:

  • oral azithromycin
  • Elidel or Protopic topical cream
  • stopping the use of steroid creams

It can also help to avoid any known triggers. For example, fluoride toothpaste is also suspected to cause perioral dermatitis in some children.

What To Know About Perioral Dermatitis

Other things to know about perioral dermatitis include that:

  • Perioral dermatitis is sometimes confused with impetigo.
  • If the rash extends into the creases around your child's nose and he has some flaking behind his ears and in his eyebrows, then he might have seborrheic dermatitis instead.
  • In some cases, there is no known trigger for a child's perioral dermatitis and there was no history of steroid cream use.
  • Angular cheilitis, or inflammation at the corners of the mouth, can be associated with iron deficiency.
  • Children with lip licker's dermatitis often suck their lower lip with their upper lip or simply lick their lips, especially during the winter. As the skin around their lips get dry and irritated, they get a rash. If treated with steroids, it can progress to perioral dermatitis. Liberal use of moisturizers is a better treatment.

If not and this doesn't sound like what is causing her rash, then you may want to see a Pediatric Dermatologist for a second opinion.

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