Periorificial dermatitis usually presents as grouped very small erythematous to pink papules, occasionally with vesicles and pustules, sometimes with surrounding erythema and fine scale (Fig. 39.1) [4]. Papules can appear more flesh colored in darker skinned individuals. Furthermore, hyperpigmentation and hypopigmentation can be seen in patients with skin of color (Fig. 39.2). Papules, vesicles, and pustules are usually ~1–3 mm in size and in the same stage. The lesions are in a perioral distribution in 70–100 % of cases, perinasal in 43–57 %, and periocular in about 25 % (Fig. 39.3). Papules and pustules less commonly appear on the cheeks, chin, neck, and forehead. Lesions may recur over weeks to months [1]. There is usually a 3–5 mm border of normal skin separating the vermilion border of the lips from the affected area (Fig. 39.4) [1]. This can be a helpful clue in determining the diagnosis. In majority of the cases the eruption is asymptomatic, but a subset of patients experience pruritus and sometimes a burning sensation. The differential diagnosis may include acne vulgaris, seborrheic dermatitis, impetigo, acrodermatitis enteropathica, and tinea faciei.