Perioral Dermatitis in a Young Adult Female
A Dermatology Case Report from Village Dermatology in Katy & Houston, Texas
Case Overview
A 29-year-old female presented to Village Dermatology as a new patient with a chronic, itchy, red facial rash localized around the mouth and nose. The rash had been present for several months and was moderate in severity. She reported partial improvement with cephalexin, but noted that a previously prescribed oral steroid worsened the eruption.
This clinical pattern raised concern for perioral dermatitis, a common yet often misdiagnosed inflammatory facial condition.
Dermatologic Examination
A focused facial examination was performed using dermoscopy. The patient appeared well-developed, well-nourished, and in no acute distress.
Clinical findings included:
Erythematous papules around the perioral and perinasal areas
Associated itching and irritation
Absence of systemic symptoms
Based on the patient’s history and exam, the findings were most consistent with perioral dermatitis rather than acne or eczema.
Diagnosis: Perioral Dermatitis (L71.0)
Perioral dermatitis is a chronic inflammatory condition that commonly affects young women and is frequently triggered or exacerbated by:
Topical or oral steroids
Cosmetics and makeup
Fluorinated toothpaste
Sun, wind, and environmental exposure
In this case, steroid use likely contributed to worsening symptoms—a classic presentation.
Treatment Plan
Because the patient is currently breastfeeding, treatment options were carefully selected to ensure safety.
Prescribed Treatment
Topical Metronidazole 0.75% Cream (MetroCream®)
Apply to the entire face once to twice daily
Daily Skin Care Regimen
Morning
Wash with a gentle cleanser
Apply metronidazole cream
Apply moisturizer with SPF 30+
Evening
Wash with a gentle cleanser
Apply metronidazole cream
Apply moisturizer on top
Patient Counseling
Minimize cosmetics and facial products
Avoid topical steroids on the face
Use only non-comedogenic skincare products
Understand that perioral dermatitis is chronic and prone to flares
The patient was advised to contact the office if symptoms worsened or failed to improve.
Coexisting Acne
The patient also exhibited comedonal and inflammatory acne. However, acne treatment will be deferred until the perioral dermatitis has resolved, as treating both simultaneously can worsen facial irritation.
Follow-Up
The patient will return in 1 month to assess response to treatment. If improvement is insufficient, topical tacrolimus may be considered.
Expert Facial Rash Care in Katy & Houston, Texas
At Village Dermatology, we specialize in diagnosing and treating complex facial rashes such as perioral dermatitis, acne, and inflammatory skin conditions. Proper diagnosis is essential—especially when steroid exposure complicates the presentation.
If you’re experiencing a persistent facial rash, our dermatology team proudly serves patients in Katy and Houston, TX with evidence-based, personalized care.
