Reassessing Potential Triggering Factors and Trends in Periorificial Dermatitis: A 12-Year Retrospective Cohort Study

Abstract

Periorificial dermatitis (POD) has historically been associated with topical corticosteroid use.  Despite greater awareness and education on safer corticosteroid use, patients continue to present with POD, prompting a reassessment of risk factors for POD and analysis of whether corticosteroid use remains a dominant factor in POD. This retrospective cohort study characterizes the epidemiology of and risk factors for periorificial dermatitis in an academic medical center from 2008-2023.

A total of 451 subjects with periorificial dermatitis were identified, of whom 79% were women and 80% were White. Age ranged from 4 months to 72 years with a mean of 32 years. Of records with clear steroid use data, 37% reported corticosteroid use within 6 months preceding diagnosis, and 23% reported topical corticosteroid use. Rates of preceding topical corticosteroid use, when excluding unknown cases, increased from 15% in subjects diagnosed 2012-2015, to 19% in 2016-2019, and 29% in 2020-2023 (p=0.03). 25% of subjects reported predisposing factors other than corticosteroids, such as facial sunscreens, whitening toothpastes, and heavy moisturizers. Topical antibiotics were the most prescribed treatment (82%).

As anticipated, the use of corticosteroids commonly precedes the development of POD, however, the 37% rate of use in our study was significantly lower than historical reports, which range from 72 – 96%. A significant proportion of POD was not preceded by corticosteroid use, indicating further research might uncover other predisposing factors and better enable prevention of POD. The remaining association between corticosteroid use and POD indicates an ongoing need for education on corticosteroid risks.