Topical cosmetics and perioral dermatitis

Abstract

Perioral dermatitis (PD) is a common dermatological disease whose aetiology and pathogenesis remain speculative. Both cosmetics and topical corticosteroids have been implicated. 75 patients with PD and 125 randomly selected control patients with negative PD records were included in a questionnaire-based study focusing on cosmetics, their use, and topical corticosteroids. The patients were assessed for atopy by clinical criteria, prick tests and specific IgE against a mixture of aeroallergens (CAP SX 1). There were no significant (p < 0.05) differences in facial skin cleansing between the two groups except for night-time cleansing, which was performed more often in the patient group. The use of skin care products yielded significant differences between the patient and control group in respect to skin care in the morning and the use of day creams. Otherwise, the groups did not differ in their skin care regime (number of skin care products used, type of product, frequency of care). The mean monthly expenditure on cosmetic products did not differ significantly between the two groups. 25.3% of the patients used topical corticosteroids which were initiated in all cases after the onset of the rash. Significantly (p < 0.001) higher values were found in the patient group regarding history of atopic diseases (49.3% vs. 15.2%), prick test reactivity (> or =2 reactive prick tests: 49.3% vs. 8.0%), and specific IgE against aeroallergens (CAP SX1 classes > or =2: 50.7% vs. 15.2%). The often heard argument that PD results mainly from external factors is no longer tenable. A variable interaction between external (e.g. cosmetics) and intrinsic factors (e.g. atopic constitution) appears to lead to PD, perhaps by subclinical repetitive irritation and final overtaxing of the reparative capacity of the epithelial barrier function.