From the Research
Treatment of perioral dermatitis should prioritize discontinuing topical corticosteroids and using oral tetracyclines, such as doxycycline, as the first-line treatment, as supported by the most recent and highest quality study 1. When managing perioral dermatitis, it is essential to consider the following key points:
- Discontinue all topical steroids, cosmetics, and facial products that may be irritating the skin 1
- Switch to a gentle, fragrance-free cleanser and avoid heavy moisturizers around the affected area
- For mild cases, topical antibiotics like metronidazole 0.75% cream or gel, clindamycin 1% solution, or azelaic acid 15-20% cream applied twice daily for 4-8 weeks are effective 2
- For moderate to severe cases, oral antibiotics are recommended, particularly tetracyclines such as doxycycline (100mg twice daily for 2-4 weeks, then tapered) or minocycline (100mg twice daily for 2-4 weeks, then tapered) 3
- For patients who cannot take tetracyclines, erythromycin (500mg twice daily) is an alternative 2
- In resistant cases, low-dose isotretinoin may be considered 1 The condition works through reducing inflammation and controlling bacterial overgrowth that contributes to the characteristic papules and pustules around the mouth, nose, and eyes. Patients should be warned that improvement is gradual and that relapses can occur, especially if triggering factors are reintroduced. Some key considerations when treating perioral dermatitis include:
- The strongest evidence supports topical corticosteroid misuse as the principal causative factor in the pathogenesis of perioral dermatitis 1
- Further research is required to robustly investigate promising treatment options, including tetracyclines, topical metronidazole, topical azelaic acid, adapalene gel, and oral isotretinoin 1
- Oral tetracycline has been shown to be significantly more effective than topical metronidazole in treating perioral dermatitis 3