Case Series of Perioral Dermatitis Caused by Improper Use of Activated Oxygen

Activated oxygen is an important chemical for disinfecting surfaces. In the last 10 years, it has become increasingly common in continuous positive airway pressure (CPAP) devices.

We sought to treat three cases of perioral dermatitis with concomitant use of CPAP devices.

Three patients presented to the clinic with the complaint of a burning and stinging skin irritation involving the bilateral malar cheeks. Physical exam revealed symmetric, scaling, well-demarcated, erythematous, and slightly indurated areas of skin involving the bilateral malar cheeks. Corticosteroids were prescribed and provided little relief. In all three cases, the CPAP masks were worn within one hour of completing the sanitizing cycle. Each patient was instructed to lengthen the time between completion of the sanitizing cycle and application of the mask to a minimum of four hours.

All patients had resolution of their symptoms within two weeks of the modification, measured by subjective resolution and photodocumentation with resolution of erythema and scaling.

Ozone follows common gas laws such that its decay time can be considered in terms of half-life. Ozone requires approximately 1,524 minutes (25.4 hours) to decay one-half life when other factors are controlled. The activated oxygen containers are a fixed environment that could be causing increased O₃ residue on the CPAP machines. The residual O₃ reacts with the natural oils on the insdividual's skin to cause perioral dermatitis.