At a glance: Perioral dermatitis versus rosacea

A rebound flare is seen after steroid use on the face
A rebound flare is seen after steroid use on the face

Perioral dermatitis
Clinical features

  • Small papules and pustules appear on an erythematous background.
  • Typically seen in young women after prolonged use of potent topical steroids on the face. When the steroid is stopped, a rebound flare may occur.
  • Increasing the strength of the steroid makes the condition worse. 

Management

  • Advise the patient to stop the topical steroid.
  • Short-term treatment with a mild steroid helps.
  • Prescribe oxytetracycline 500mg twice daily, gradually reducing over a few weeks.
  • Treat underlying acne or seborrhoeic dermatitis.

Rosacea
Clinical features

  • The cheeks, nose and centre of the forehead are most commonly affected.
  • Discrete domed or inflamed papules or papulopustules are seen, with telangiectasia.
  • Usually symmetrical with a prolonged course of exacerbations and remissions.

Management

  • Topical antibiotics or oral tetracyclines.
  • Avoid precipitating factors such as alcohol.
  • Potent steroids may cause a rebound flare of pustules that is worse than before treatment.  

Contributed by Dr Nigel Stollery, a GP in Kibworth, Leicestershire and clinical assistant in dermatology at Leicester Royal Infirmary

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