Aprile Vol.2 N° 1 - 2006 - Salute per tutti

Cosmetici e corticosteroidi topici
nella dermatite periorale
il ruolo dell’isopropil miristato
Francesco Bruno
SUMMARY
Cosmetics and topical corticosteroids
in perioral dermatitis: the role of
isopropyl myristate
Dermatologo, Palermo
Perioral dermatitis (PD) is a common dermatological disease which is not easy to
classify, and whose aetiology and pathogenesis, even today, remain speculative and
controversial. PD mainly affects women aged 15-50 years, and is increasing in occurrence.
The feature shows discrete papules and pustules 1-2 mm in diameter, with follicular
location, despite the shortage of follicles in this area. The arrangement is
symmetrical around the border and corners of the mouth, often extending to the
nasolabial folds, sparing a zone close to the vermilion border. There may be isolated
periocular involvement (periocular dermatitis).
Since Frumes and Lewis, described PD as a “light sensitive seborrheid” in 1957, and
Steigler and Strempel as a “rosacea-like dermatitis” in 1968, several erroneous
pathogenetic theories have followed. One of the most prominent of these, is the relation
between acne and PD, despite the absence of comedones. There are a myriad of
different pathogenetic theories: intestinal malabsorption, infection by candida or
fusobacteria, sunlight - heat or cold - exposure, hormones, and oral contraceptives.
Nowadays, all these different factors have merely a historical significance.
Almost all the women affected by PD have a positive history of intensive use of
cosmetics, fragrances, and /or topical corticosteroids. The cosmetics mostly used are
skin care products such as moisturizers, detergents, abrasives, adstringents, night -
antiwrinkle creams, and make-up products.
All these products contain a variable concentration of isopropyl myristate (IPM).
IPM is also contained in topical steroids and antimycotics. IPM is considered a very
weak sensitizer. However, in patients affected by PD, patch tests are often positive
because these patients are atopics in a high percentage and because they also have
positive history of a cosmetics allergy.
It’s very important to investigate the skin barrier function as well. In fact, in patients
with PD and atopy, transepidermal water loss (TEWL), measured on the face, is
significantly increased.
Treatment consists of avoiding the use of all kinds of cosmetics such as soaps and moisturizers,
although it is often the case that the patient doesn’t accept this advice easily.
KEY WORDS: Cosmetics, Topical corticosteroids, Isopropyl myristate, Atopy
La dermatite periorale (DP), rappresenta ancora
oggi una dermatosi dall’etiopatogenesi assai
controversa, conseguentemente non è facile una
sua “collocazione” dal punto di vista nosologico
(1, 2). La sua incidenza sembra essere in aumento.
È caratterizzata dalla presenza di numerose
papule di pochi millimetri di diametro. Si associa
un eritema finemente desquamante. Le
papule hanno una localizzazione prevalentemente
follicolare, nonostante la scarsità di follicoli
in questa area. Si può associare una sensazione
di modico prurito e bruciore (Figure 1-4).
Journal of Plastic Dermatology 2006; 2, 1
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