Periocular dermatitis

What is periocular dermatitis?

Periocular dermatitis is a localised form of periorificial dermatitis. It is characterised by small red scaly papules and pustules located around the eye [1].

Periorificial dermatitis includes perioral dermatitis or periocular dermatitis alone, or in association.

• Perioral dermatitis describes an eruption around the mouth and nose.
• Periocular dermatitis is confined to the skin around the eyes [2].

Who gets periocular dermatitis?

• Periocular dermatitis is not uncommon. It most often arises in women between the ages of 16 and 45 years [2,3].
• It can also affect children [4].
• It often occurs in people using topical corticosteroids.

What causes periocular dermatitis?

The cause of periocular dermatitis is not well understood. It is thought to be due to a combination of environmental and genetic factors [3].

Periocular dermatitis may be related to [3,5]:

• An impaired skin barrier – there is an association between atopic dermatitis and periocular dermatitis
• Disturbance of follicular microflora
• Alteration of the pilosebaceous unit.

Triggers for periocular dermatitis

Medications [4,5]

• Topical corticosteroids, especially those of high potency or fluorinated
• Inhaled and systemic corticosteroids

Cosmetics

• Makeup
• Sunscreen
• Moisturisers [4]

Dental preparations [3]

• Fluoride-containing toothpaste
• Amalgam dental fillings

Microorganisms [4,5]

• Candida albicans
• Demodex folliculorum
• Fusiform bacteria

Other triggers [4,5]

• Hormonal supplements, including oral contraceptives
• Environmental factors, such as ultraviolet light, heat, cold and wind
• Emotional stress

What are the clinical features of periocular dermatitis?

Clinical features of periocular dermatitis include:

• Involvement of the areas surrounding the eye, including the upper and lower eyelids [1,3,5]
• Small erythematous papules and, less commonly, papulopustules and/or papulovesicles
• Scaling [3]
• Pruritus [3] or a burning sensation [5]
• Erythematous dry background skin [1,4].

Periocular dermatitis 

Periocular dermatitis 

Periocular dermatitis 

How is periocular dermatitis diagnosed?

The clinical presentation of periocular dermatitis is usually typical, and thus it is generally diagnosed on clinical examination [4].

In the unlikely event that a skin biopsy is taken, the histology shows non-specific inflammation, with perifollicular or perivascular lymphohistiocytic infiltration [3,4].

What is the treatment for periocular dermatitis?

General measures

• Stop applying all skin creams to the area, including topical corticosteroids, moisturisers, sunscreen, and makeup [5].
• If the patient is using topical corticosteroids, there is a risk of a severe flare after cessation. Consider tapering the topical corticosteroid by decreasing the potency or reducing the frequency of application [3,4].

Topical therapy

Topical therapy may be effective for mild disease [3]. Options include [6]:

• Metronidazole
• Erythromycin
• Clindamycin
• Azelaic acid
• Pimecrolimus
• Tacrolimus.

Oral therapy [4,6]

Oral therapies may be used alone or in addition to topical treatment for moderate and severe disease. Treatment may be required for up to 3 months.

• Tetracycline antibiotics, such as doxycycline or minocycline, are the treatments of choice.
• Macrolides, including erythromycin, are used in children aged under 11 years.
• Isotretinoin is usually reserved for treatment-resistant periocular dermatitis.

What is the outcome for periocular dermatitis?

Periocular dermatitis usually resolves with appropriate management, although it may take some weeks or even months to clear up.

It can be prevented by avoiding applying potent topical corticosteroids and thick face creams around the eye.