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doi: 10.1111/adj.12077
ABSTRACT
Perioral dermatitis is a papulopustular eruption, commonly related to the inappropriate application of topical corticoster-
oids with occasional reports of inhaled corticosteroids and decreased personal hygiene. We present a case of a 45-year-
old female with a one-year history of perioral dermatitis related to the use of highly fluoridated toothpaste commenced
to control dental caries.
Keywords: Dermatology, adverse reaction, fluoride.
(Accepted for publication 28 October 2012.)
CASE DESCRIPTION
Our patient, a 45-year-old female, had been com-
menced on a high concentration sodium fluoride tooth-
paste, NeutraFluor 5000 Plus (Colgate) for the control
of dental caries. Following five years of use, she began
to note the presence of a papulopustular eruption in
the perioral region. She was not on any other medica-
tions and did not regularly use makeup on her face,
although she did use daily lipstick. Her face washing
habits were unremarkable. Following consultations
with her dentist and general practitioner, and based
upon suspicions that the high fluoride toothpaste could
be a contributing factor (she was not taking other pre- Fig. 1 Persistent pustular lesion continuing after switching from high to
regular uoridated toothpaste. These lesions were widespread when using
scription or over-the-counter medication), she ceased the high uoridated toothpaste.
the high fluoride toothpaste and was commenced on a
regularly fluoridated toothpaste (Macleans Protect
(GSK)) with improvement but not resolution of her Investigations into the source of the perioral derma-
symptoms (Fig. 1). Retrial of her high fluoride tooth- titis indicated the role of the toothpaste that was
paste saw a subsequent flare up of her perioral dermati- being used at the time, as the patient was not on any
tis, leading to cessation of the use of the high fluoride other systemic or topical medications. Colgate Neu-
toothpaste and referral to a dermatologist. Upon pre- trofluor 5000 Plus is a high fluoride toothpaste,
sentation, the perioral dermatitis had continued to available in Australia as a pharmacy only product.
improve, however there remained several small, persis- The active ingredient in this toothpaste is 1.1%
tent regions on her right cheek. At no time were the lips sodium fluoride, whereas the sodium fluoride con-
or the oral cavity affected and the patient denied the tained within Macleans Protect is 1024 PPM
use of any potent topical or inhaled corticosteroids. (Table 1).
The patient was commenced on eryacne (topical Perioral dermatitis has also been reported from
2% erythromycin) and topical azeliac acid to control tartar controlled toothpaste with a case series pre-
symptoms associated with her dentists choice of sented by Beacham et al.1 which concluded that the
toothpaste which resulted in an improved outcome. circumoral dermatitis noted appeared to be brush
2013 Australian Dental Association 371
P Peters and C Drummond
Table 1. Dentifrices used and active ingredients perioral dermatitis but included stomatitis, cheilitis,
contained glossitis, gingivitis and immediate hypersensitivity.
Toothpaste PPM Active ingredient