From the Research
Yes, doxycycline prescribed for periorbital dermatitis can cause heartburn as a common side effect, and if a patient has not improved with both pimecrolimus and doxycycline, the next step would typically be to consider alternative treatments. The most recent and highest quality study 1 suggests that the etiology of perioral dermatitis, which shares similarities with periorbital dermatitis, is not completely understood, but topical corticosteroid misuse is a principal causative factor. Given the lack of improvement with pimecrolimus (a topical calcineurin inhibitor) and doxycycline, the next steps in management could include:
- Oral isotretinoin (such as Accutane) at a low dose of 10-20 mg daily for 3-4 months, with mandatory pregnancy testing and effective contraception for women of childbearing potential due to its teratogenic effects.
- Topical ivermectin, azelaic acid, or metronidazole if not previously tried, as these have shown promise in treating perioral dermatitis, a condition with similar characteristics to periorbital dermatitis.
- A short course of low-potency topical steroids might be cautiously used to reduce inflammation, under close supervision, as steroids can potentially worsen periorbital dermatitis long-term. It's crucial to identify and eliminate underlying triggers such as cosmetic products or environmental factors, and adjust the treatment approach based on the severity of symptoms and patient tolerance, as suggested by studies 2, 3, 4, 5.