How to Distinguish Perioral Dermatitis vs Lupus Rashes

Introduction to Perioral Dermatitis and Lupus

Facial rashes can have many underlying causes ranging from minor skin irritation to more serious systemic autoimmune diseases. Two conditions that often present similar external skin findings are perioral dermatitis and cutaneous lupus erythematosus.

However, despite resemblances in rash appearances, perioral dermatitis and lupus stem from very different mechanisms internally. Understanding how to distinguish these diseases is crucial for selecting appropriate treatment methods to resolve symptoms.

Characteristic Differences Between Conditions

While both perioral dermatitis and certain types of lupus rashes may first appear as facial redness, there are classic features that set them apart:

• Perioral dermatitis typically starts around nasal folds, while lupus first appears on cheeks and nose
• Lupus rashes are more widespread rather than concentrated in one area of skin
• Scaly, itchy skin and pustules point more towards perioral dermatitis
• Sun exposure reliably worsens lupus rashes specifically

Understanding Perioral Dermatitis

Who Gets Perioral Dermatitis?

Perioral dermatitis most often affects women ages 16 to 45 years old. However, men and children sometimes develop symptoms as well.

Distinctive Features of Condition

Hallmark signs setting perioral dermatitis apart include:

• Clusters of small red bumps and papules around mouth and nasal folds
• Occasional pustules and tiny surfaced blisters
• Flaking, itchy irritated skin patches
• Asymmetrical distribution favored on one side

Possible Triggers to Avoid

Perioral dermatitis flares can arise in response to external irritants and sources:

• Heavy cosmetics, skin creams, and ointments
• Topical steroid overuse on face
• Fluoridated toothpastes near mouth
• Harsh soaps, oils, scrubs activating sensitive facial skin

Comparing to Cutaneous Lupus Erythematosus

Underlying Autoimmunity

The rashes associated with lupus stem from an overactive immune system mistakenly attacking the body's own healthy tissues, unlike perioral dermatitis.

Range of Lupus Rash Types

Cutaneous lupus encompasses several specific rash subsets and naming variations:

• Acute cutaneous lupus erythematosus (ACLE)
• Subacute cutaneous lupus erythematosus (SCLE)
• Chronic cutaneous lupus erythematosus (CCLE)

Each lupus rash subtype has defining characteristics setting it apart.

Underlying Photosensitivity

Many forms of lupus rashes worsen substantially following exposure to ultraviolet and sunlight, unlike perioral dermatitis triggered more by topicals.

Distinguishing Appearance of Rashes

Despite some visual resemblance in redness, closer inspection reveals distinguishing features between perioral dermatitis and various lupus rashes.

Malar Rash of ACLE

The classic malar "butterfly" facial rash of acute cutaneous lupus erythematosus first appears symmetrically on the cheeks and nose bridge rather than around mouth and eyes.

Widespread SCLE Lesions

Subactue cutaneous lupus erythematosus arises as widespread red flat lesions rather than concentrated patches favored by perioral dermatitis.

Discoid Lupus (CCLE) Plaques

The coin-shaped scaly inflamed plaques of DLE/chronic cutaneous lupus have more extreme texture changes compared to perioral pustules and papules.

Diagnostic Testing Options

Doctors may utilize the following diagnostic tests to distinguish perioral dermatitis from various forms of cutaneous lupus:

Skin Biopsies

A punched biopsy examining sample skin layers under a microscope can reveal differences in immune cell infiltrates and tissue damage patterns between conditions.

Blood Tests

Blood tests check for elevated antinuclear antibodies (ANA) and antibodies against double-stranded DNA which are hallmarks detecting systemic lupus erythematosus.

Direct Immunofluorescence

This special laboratory analysis can reveal increased deposits of immunoglobulin and complement proteins lighting up skin tissues under UV light indicating lupus.

First Line Treatment Options

Doctors tailor treatment approaches to underlying causes once a definitive diagnosis is made:

Antibiotics and Topical Metronidazole

Bacterial overgrowth may provoke inflammation in periorial dermatitis, therefore antibiotics like tetracycline or topical antibiotic metronidazole provide first-line relief.

Immunosuppressants for Lupus

With autoimmunity confirmed from blood panels, rashes arising in cutaneous lupus are managed with medications suppressing inflammatory immune reactions such as hydroxychloroquine, topical steroids, acitretin or in severe refractory cases brief systemic steroids.

Preventing Recurrence of Rashes

Patients achieve the best long-term facial skin clearance by tailoring avoidance measures to their confirmed underlying condition:

Irritant Avoidance

individals with perioral dermatitis benefit from steering clear of irritating skin creams, makeup products and toothpastes provoking inflammatory reactions near mouth and eyes.

Sun Protection Measures

Strict photoprotection using broad-spectrum sunscreens, protective hats and clothing represents the cornerstone for preventing recurrent flare-ups of sunlight-exacerbated lupus rashes.

Discuss options for managing triggers with your personal dermatologist to keep facial skin clear.

In Conclusion

In summary, while the facial redness arising in perioral dermatitis and cutaneous lupus may initially look comparable, critical subtle differences in rash features, triggers, and recommended treatments sets these conditions miles apart. Therefore obtaining an accurate diagnosis represents the crucial first step guiding appropriate personalized skin care.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.