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40-Year-Old Female with Perioral Rash Around Mouth

Can you diagnose this case?

Signs and Symptoms

This 40-year-old woman presented with a 2-month history of a rash around the mouth that she described as slightly itchy. She had not had acne as a teenager and was distressed by the appearance of the lesions. She denies any exposure history as a possible cause. She is otherwise healthy.

What is the cause of this woman’s perioral rash?

Choose one to reveal diagnosis and discussion

Flat warts
Perioral dermatitis
Demodex folliculitis

Answer: Perioral dermatitis

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This patient had perioral dermatitis, a common condition in adult women that is manifested by erythematous, slightly scaly papules in a perioral distribution. This condition can be exacerbated by topical corticosteroid use. There is a variant seen in children that is often precipitated by toothpaste with added ingredients such as flavorings or tartar control. This condition responds best to oral tetracycline antibiotics but will sometimes respond to topical therapy.

Rosacea usually occurs on the mid-face with erythema and telangiectasia. Hormonal acne can appear on the chin area but usually has a history of worsening with menses. Flat warts do not have scale but can be difficult to discern. Demodex folliculitis is usually manifested by minute pustules, unlike what is seen here.

David L. Kaplan, MD, is a clinical assistant professor of dermatology at the University of Missouri–Kansas City School of Medicine in Kansas City, Missouri, and at the University of Kansas School of Medicine in Kansas City, Kansas. He practices adult and pediatric dermatology in Overland Park, Kansas.