Eruptions typically begin around the mouth (perioral region) in the nasolabial folds (smile lines) and can spread to the sides of the nose (perinasal region), the chin, the cheeks, or even the lateral aspect of the lower eyelid (periorbital region).Sometimes the rash only appears at the eyelids (despite the name “perioral” dermatitis).
It is believed that in individuals with constitutionally dry skin, the overuse of moisturizers causes the surface of the skin (the horny layer) to be constantly artificially hydrated, thus affecting this layer’s ability to inhibit the growth of bacteria.
They all claim to have had no contact with steroid creams and they appear to wear minimal amounts of makeup (if any).
Perhaps there is a common chemical or cleanser they are coming into contact with that is triggering this? In each of these cases, the rash improves on days when the patient is not at work or when they are on vacation and it reappears or gets noticeably worse when they return to work.
Eczema/AD can be asymmetrical, while perioral dermatitis is typically symmetrical.
Blood tests for Ig E levels can be helpful to determine if it is eczema/AD.