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Perioral Dermatitis

Expert Q&A

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Updated April 23, 2014

Q. My 2 year old daughter has very fair, sensitive skin. About 6 months ago she started getting a rash on her chin. Sometimes it is very red and shiny, other times it is pale and chaffed. It doesn't seem to itch but when she eats fruit and the juices touch it, it seems to sting. It has since seemed to spread. She has several round spots on her face. The spots are raised and sort of chapped. Sometimes they will completely go away, but within a couple days they return in the exact same spots. Her pedi said he's not sure what it is, probably just dry skin. I don't think this is right. I always put moisturizers on her and have recently started using neosporin. Please clue me in to what this could be, I'm concerned. She is a redhead and very fair-skinned, I'm afraid she will have scars if I let this persist. Or even worse, if it could be something more serious that I should look into. I would really appreciate a reply. Thank you. Michelle, Merrimack, NH

A. Have you been putting a steroid cream on it, such as an over-the-counter hydrocortisone cream or a stronger, prescription strength steroid cream? If so, then she may have perioral dermatitis, a chronic rash that is caused by using steroid creams on a child's face.

In many situations, a child has a simple rash caused by irritation and is treated with a steroid cream. While that helps the rash get better for a little while, it then gets worse again and eventually doesn't respond to the steroid cream anymore.

If you are using a steroid cream and think that she may have perioral dermatitis, then you should stop using it. Be warned that the rash will get worse once you stop using the steroids and will then gradually get better. Sometimes, a topical or oral antibiotic is also needed to help perioral dermatitis go away.

Protopic ointment may also be effective and even with the new drug warnings can still be used for children over age 2 for short periods of time when other treatments aren't effective. Using it to treat perioral dermatitis would be considered 'off-label' though.

Keep in mind that fluoride toothpaste is also suspected to cause perioral dermatitis in some children.

Does her rash look like any of these pictures of children with perioral dermatitis?

Does it sound like this description of perioral dermatitis from the American Academy of Dermatology?

If not and this doesn't sound like what is causing her rash, then you may want to see a Pediatric Dermatologist for a second opinion.

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