Perioral dermatitis: a widespread disease and its causes

It is popularly known as stewardess disease: Perioral dermatitis mainly affects women and predominantly those who attach great importance to their appearance and therefore damage their facial skin with too many and wrong cosmetics. Antibiotics is usually the treatment of choice for those affected by this type of dermatitis. Affected people mainly complain about the stress caused by a "disfigured face" and the associated psychological implications.

Why stewardesses have to serve as namesakes

Perioral dermatitis manifests itself as redness and inflamed pustules around the mouth or, in the case of perinasal or periocular dermatitis, also on the nose or around the eyes (1). The affected areas itch and feel uncomfortable. Apart from this and the visual impairment, perioral dermatitis is harmless and not contagious. The rash is similar to acne, rosacea or shingles, which is why the term rosacea-like dermatitis is used as a synonym. The pustules are usually chronic, but can also sometimes wax and wane.

The causes of perioral dermatitis have not been finally clarified, but there are a number of circumstances that are considered triggers or risk factors: Above all, over-treated skin is considered to be particularly susceptible. This circumstance, in connection with the high proportion of female patients, gave rise to the term "stewardesses' disease" in the vernacular. The excessive use of creams with unsuitable ingredients attacks and destroys the skin's natural protective layer. The result is the well-known pustules of perioral dermatitis.

Other possible triggers of perioral dermatitis

In addition to the extreme use of care and cosmetic products, sun exposure, hormonal preparations such as the birth control pill, fungal infestation of the affected skin areas, and intrinsic factors such as psychological stress are also triggers (2). As with most diseases, a combination of factors is considered the most likely trigger. Basically, it should be noted that the microbiome of the facial skin is always disturbed in perioral dermatitis cases, although the cause-and-effect relationship has not been finally clarified.

Nevertheless, the suspicion arises that the inflammatory skin disease is encouraged if the already sensitive facial skin is frequently exposed to the influence of personal care products and the finely balanced ecosystem of the microbiome is disturbed. If the normal microbial residents of the skin of the affected skin areas are decimated, this gives pathogens a boost that can trigger inflammatory reactions. But also “drying out” or “excessive oiliness” of the skin areas can lead to intolerance reactions, usually in the form of an inflammatory rash (3).

Treatment of perioral dermatitis

As part of the treatment, the patient (in most cases) is advised not to use cosmetics for several weeks. That alone often leads to success, the greatest challenge for those affected is to resist the temptation to use additional creams to relieve the itching or to conceal the pustules and papules by applying make-up. Since it is mainly women who are affected, who attach great importance to their appearance and have therefore used too many products from the outset, this time of not being allowed to do anything and being disfigured is also associated with a certain psychological stress for many of those affected.

Antibiotics are often prescribed to speed healing. As always, the antibiotic should only be used when absolutely necessary and should be taken or applied for the entire duration of the prescribed application. Otherwise, antibiotic resistance easily develops and the disease can become chronic or reappear in flares.

For prevention, pay attention to the microbiome of the facial skin

Of course, the best thing to do is not to damage the skin to the point where perioral dermatitis occurs. This can be done by deliberately minimizing care products. The ones you can't and won't do without should be microbiome-friendly and leave the facial skin's microbiome in its natural balance.

Sunscreen is generally recommended, as frequent, direct exposure to the sun has a massive impact on the skin. Nevertheless, caution is advised when choosing sunscreen, and strong products with unsuitable UV filters are not recommended in any case (more on this in our sunscreen article.

Giving up smoking, eating a healthy diet, avoiding contact with aggressive substances - all these are aspects that alone cannot trigger or prevent perioral dermatitis, but in conjunction with other factors they can increase the risk of disease. If you take your microbiome into account, you will definitely create a good basis for stable skin health.

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