HPI: The patient is a 44 yo health care professional with an 18 month history of erythema of the chin and perioral area. She has been seen by four dermatologists who have treated her for rosacea and perioral dermatitis with doxycycline and various topicals. Nothing has helped. The process began after her mother died. She lives at home with her boyfriend of 16 years and their two preteen children.
She admits to being anxious and depressed as there
are significant social problems at home.
She used a topical steroid for a few days when her lips were
prurituc, not for weeks to months.
She takes no medications p.o. other than Xanax 0.25 mg h.s. There is no history of using a mask or any local contactant to this area that might explain this pattern.
O/E: Shows a
light-complected Caucasian with sharply demarcated erythema and mild scaling of
the chin, and submental region.
Clinical Images:
Patch Testing: True Test negative at 96 hours
Discussion: This is a perioral rash that does not look like perioral dermatitis. The pattern suggests a contact dermatitis, but the history and patch testing do not corroborate that. Perhaps, one of our readers will have had a similar patient. At present, this is medically unexplained, but I suspect that I am missing something.
Addendum: See comments of Dr. Howard Maibach.
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