There is some evidence that fungi and bacteria may be underlying causes of the disorder. However, this has not been proven. Stress also plays a role, as does repeatedly touching the skin on the face. Often the papules develop around the eyes and nostrils as well. The next stage of POD brings scaling and reddening.
Some patients experience burning and itching.
POD has a tendency to improve and worsen at variable intervals. In the lab, skin biopsy samples look similar to those of rosacea patients. Patients should be careful not to touch or scratch the affected area, as this can make the disorder worse. With treatment, most POD patients experience complete clearing. However, this process may take 2 or 3 months.