Perioral dermatitis: Diagnosis, proposed etiologies, and management

J Cosmet Dermatol. 2021 Dec;20(12):3839-3848. doi: 10.1111/jocd.14060. Epub 2021 Mar 16.


Background and aims: Perioral dermatitis is a common cutaneous condition characterized by acneiform facial eruptions often with an eczematous appearance. A granulomatous subtype exists in addition to the classic variant. While topical corticosteroids have been largely implicated in this condition, its etiology is not completely understood.

Methods: Using the keywords "corticosteroids," "dermatology," "fusobacteria," "perioral dermatitis," and "periorificial dermatitis," we searched the databases PubMed, MEDLINE, and EMBASE to find the relevant literature. Only articles in English were chosen. The level of evidence was evaluated and selected according to the highest level working our way downwards using the Oxford Centre of Evidence-Based Medicine 2011 guidance.

Results: This systematic review found the strongest evidence to support topical corticosteroid misuse as the principal causative factor in the pathogenesis of perioral dermatitis.

Conclusion: In terms of treatment, further research is required to robustly investigate promising treatment options including tetracyclines, topical metronidazole, topical azelaic acid, adapalene gel, and oral isotretinoin.

Keywords: corticosteroids; demodex; fusobacteria; maskne; perioral dermatitis.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Dermatitis, Perioral* / diagnosis
  • Dermatitis, Perioral* / drug therapy
  • Dermatitis, Perioral* / etiology
  • Dermatologic Agents* / therapeutic use
  • Humans
  • Isotretinoin
  • Metronidazole / therapeutic use


  • Anti-Bacterial Agents
  • Dermatologic Agents
  • Metronidazole
  • Isotretinoin