From the Guidelines
Perioral dermatitis is a facial rash that appears as small red bumps or pustules around the mouth, nose, and sometimes eyes, and its management begins with stopping all topical steroids, which often trigger or worsen the condition, as stated in 1. Management of perioral dermatitis involves a combination of oral and topical treatments.
- The first-line treatment is typically oral tetracycline antibiotics, such as doxycycline 100mg twice daily for 4-8 weeks, or minocycline 100mg twice daily for a similar duration.
- For those who cannot take tetracyclines (like pregnant women or children), erythromycin 500mg twice daily is an alternative.
- Topical treatments include metronidazole 0.75% gel, azelaic acid 15-20% cream, or pimecrolimus 1% cream applied twice daily for 4-12 weeks. During treatment, it is essential to use only gentle, fragrance-free cleansers and avoid heavy moisturizers, makeup, and fluorinated toothpaste around the affected area. Improvement typically begins within 2-4 weeks, but complete resolution may take several months, as these antibiotics work primarily through anti-inflammatory effects rather than antimicrobial action, as noted in 1. Patients should be advised that the condition may recur and that maintaining a simple skincare routine helps prevent flare-ups. It is also important to note that greasy creams for basic care, manipulation of skin, hot blow-drying of the hair, wearing of tight shoes, topical acne medications, and topical steroids should be avoided, as they may worsen the condition or cause unwanted side-effects, as stated in 1.
From the Research
Perioral Dermatitis
Perioral dermatitis is a common acneiform facial eruption found in both adults and children, with variants including periorificial and granulomatous periorificial dermatitis 2. The etiology of perioral dermatitis remains unknown, but topical corticosteroid use on the face commonly precedes the manifestation of this condition 2, 3.
Clinical Presentation
The clinical presentation of perioral dermatitis is characterized by an eruption of erythematous papules, pustules, and papulovesicles in the perioral region, with a typical narrow spared zone around the edge of the lips 3, 4.
Management
The management of perioral dermatitis includes:
- 'Zero therapy', which involves discontinuing the use of cosmetics and topical corticosteroids, and is often effective in mild cases 3, 5
- Topical metronidazole, erythromycin, and pimecrolimus, which have been shown to be effective in reducing the severity of the disease 2, 3, 5, 4
- Oral tetracycline, which is considered the first-line treatment for more severe cases, but may not be suitable for children under 8 years old 2, 5, 6
- Systemic isotretinoin, which may be considered for patients refractory to standard therapies 3
Treatment Algorithm
A treatment algorithm has been proposed to assist dermatologists, pediatric dermatologists, and general practitioners in managing perioral dermatitis, taking into account the severity of the clinical presentation and the patient's age 2.
Images
Unfortunately, there are no images provided in the available evidence. However, perioral dermatitis is typically characterized by an eruption of erythematous papules, pustules, and papulovesicles in the perioral region, with a typical narrow spared zone around the edge of the lips 3, 4.