Association of Nasal and Inhalant Corticosteroids With Pediatric Perioral Dermatitis: A <scp>TriNetX</scp> Retrospective Cohort Study

Although topical corticosteroids are known triggers in the development of perioral dermatitis (PD), investigation into inhalant and nasal corticosteroid preparations, commonly used to manage allergic rhinitis and asthma, remains limited to case series. Using the TriNetX US Collaborative Network, this retrospective cohort study identified pediatric patients (age < 18) with allergic rhinitis or asthma in three groups: corticosteroid nasal/inhalant users, non-steroid nasal/inhalant users, and controls with no nasal/inhalant product use. Patients were propensity score matched 1:1 from 2000 to 2025 with a new diagnosis of PD as the outcome assessed at 6 and 12 months. Corticosteroid nasal/inhalant usage showed an increased association of newly documented PD with the strongest signal occurring within 6 months (RR 3.25, p < 0.0001) remaining persistently elevated although attenuated by 1 year (RR 2.27, p < 0.0001), whereas nonsteroidal preparations showed no such association. Nasal and inhalant containing corticosteroid preparations were clearly associated with PD in this large retrospective database study. They represent a likely underrepresented trigger necessitating clinician attention when encountering new-onset pediatric facial dermatoses.