Perialar dermatitis

Perialar Intertrigo in Children and Adolescents

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BACKGROUND/OBJECTIVES

We observed isolated cases of perialar intertrigo in children and teenagers that did not appear to correspond to any known clinical entity. The objective of this study was to describe the clinical features of this dermatosis and the clinical characteristics of the patients.

METHODS

We conducted a prospective, multicenter cohort study in France from August 2017 to November 2019. All the patients under 18 years of age with chronic perinasal intertrigo were included. A standardized questionnaire detailing the clinical characteristics of the patients and the description of the intertrigo. If possible, a Wood's lamp examination of the intertrigo was done.

RESULTS

Forty-one patients were included (25 boys and 16 girls, average age: 12.1 years). Intertrigo was bilateral in 38 patients (93%). The majority of patients had no symptoms (54%). Pruritus was present in 39% of cases. Orange red follicular fluorescence was present in the perialar region on Wood's light examination in 78% of cases with active fluorescence. The presumptive diagnoses suggested by the investigators were acne (24.4%), seborrheic dermatitis (19.5%), rosacea (9.8%), psoriasis (9.8%) and perioral dermatitis (7.3%). No diagnosis was proposed in 22% of the cases.

CONCLUSIONS

We describe a previously undescribed clinical sign which is characterized by a chronic bilateral erythematous intertrigo located in the perialar region. It can be isolated or associated with various facial dermatoses.

TAKE-HOME MESSAGE

• After observing numerous cases of isolated erythema of the nasal folds in their pediatric dermatology practices, the authors performed a prospective, multicenter cohort study to better characterize this manifestation. After excluding cases attributed to other facial dermatoses, 41 cases of perialar intertrigo were identified. Most patients presented with asymptomatic bilateral erythema around the nasal ala with mild desquamation. Of the patients who showed fluorescence in the perinasal area with Wood's lamp examination, most showed orange–red follicular fluorescence. Various treatments were attempted, but none of them resulted in uniform success.

• More studies are needed to elucidate the etiology and treatment of the newly described central facial cutaneous manifestation "perialar intertrigo."

–  Katherine M. Stiff, MD

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Sarah L. Chamlin MD

I see this disorder as a presenting complaint and incidentally in my practice and have considered it an overlap of periorificial dermatitis and seborrheic dermatitis. This article nicely describes this and gives it a name, perialar dermatitis, and the photos published are very typical of this overlap condition. Unfortunately, follow-up and response to treatment were not reported. 

I have had a few treatment failures for this by using pimecrolimus 1% cream and metronidazole 0.75% cream, each once daily. Patients are also counseled that recurrences are typical.  

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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