Of approximately 65 patients with treatment-refractory acne-like perioral dermatitis, all had been using toothpaste containing fluoride. When these patients were switched to non-fluoridated toothpaste, about half had a clearance of their lesions within two to four weeks. The non-responders then switched from their present toothpaste, which contained brightening and flavoring agents and other unknown chemicals, to baking soda and a commercially available mouthwash after brushing. Nearly all of these patients had almost complete clearing of their lesions. Patients who resumed fluoride toothpaste invariably developed a recurrence of the dermatitis. Of patients who were able to recall, all stated that the side on which they had the most severe dermatitis was the side on which they generally slept. That observation supports the hypothesis that nocturnal salivary drainage of chemicals onto the involved areas of skin exacerbates the lesions.

Comment: Perioral dermatitis affects up to 1% of the population, and is more prevalent among women than among men. It is characterized by chronic papulopustular lesions around the mouth that resemble rosacea. Perioral dermatitis was first described in 1957, around the time that fluoridated toothpaste was introduced in the United States. In 1967, the German literature described perioral dermatitis as a "new entity." The delayed recognition of this condition in Germany may have been related to the later marketing of fluoridated toothpaste in that country. The results of the present study suggest that sensitivity to fluoride or to other ingredients in toothpaste is the most important cause of perioral dermatitis.

Saunders MA Jr. Fluoride toothpastes: a cause of acne-like eruptions. Arch Dermatol 1975;111:793.