From the Guidelines
To treat perioral eczema, start with gentle skincare and topical treatments, using a mild, fragrance-free cleanser and applying a topical corticosteroid cream such as 1% hydrocortisone for up to 7 days to reduce inflammation, as recommended by recent guidelines 1. When managing perioral eczema, it is essential to avoid harsh soaps and potential triggers, including fluoride toothpastes, cinnamon flavoring, and certain foods.
- Use a mild, fragrance-free cleanser like Cetaphil or CeraVe
- Apply a topical corticosteroid cream such as 1% hydrocortisone for up to 7 days to reduce inflammation
- For maintenance, use a barrier repair moisturizer like Vanicream or La Roche-Posay Cicaplast Baume B5 several times daily
- Topical calcineurin inhibitors such as tacrolimus (Protopic) 0.03% or pimecrolimus (Elidel) 1% are steroid-free alternatives that can be used twice daily for longer periods, as suggested by recent studies 1. Perioral eczema involves inflammation of the skin barrier around the mouth, and these treatments work by reducing inflammation and restoring the skin's protective function. If symptoms persist beyond 2-3 weeks of treatment or if there's significant worsening, consult a dermatologist as oral antibiotics or stronger prescription treatments may be necessary, considering the latest guidelines and recommendations 1.
From the FDA Drug Label
ELIDEL Cream is a prescription medicine used on the skin (topical) to treat eczema (atopic dermatitis). ELIDEL Cream is for adults and children age 2 years and older who do not have a weakened immune system. Use ELIDEL Cream exactly as prescribed. Use ELIDEL Cream only on areas of your skin that have eczema. Use ELIDEL Cream for short periods, and if needed, treatment may be repeated with breaks in between.
The treatment for perioral eczema is not explicitly mentioned in the provided drug labels. However, since perioral eczema is a type of eczema (atopic dermatitis), and ELIDEL Cream is used to treat eczema (atopic dermatitis), it can be inferred that ELIDEL Cream may be used to treat perioral eczema.
- Key points to consider when using ELIDEL Cream to treat perioral eczema:
- Use ELIDEL Cream exactly as prescribed by your doctor.
- Apply a thin layer of ELIDEL Cream only to the affected skin areas, twice a day.
- Use the smallest amount of ELIDEL Cream needed to control the signs and symptoms of eczema.
- Stop ELIDEL Cream when the signs and symptoms of eczema go away, or as directed by your doctor.
- Follow your doctor’s advice if symptoms of eczema return after a treatment with ELIDEL Cream 2.
From the Research
Treatment Options for Perioral Eczema
- Oral tetracycline is considered a first-line treatment for perioral dermatitis, as it significantly shortens the time to papule resolution 3, 4.
- Topical metronidazole, erythromycin, and pimecrolimus are also effective treatment choices with good evidence 3, 4.
- Topical corticosteroid use is common in these cases, but its role as a cause or treatment remains unclear, and there is a risk of rebound when treatment is stopped 3, 5.
- "Zero therapy", which involves discontinuing the use of cosmetics and topical corticosteroids, can be an effective treatment option, especially for self-limited cases of perioral dermatitis 4.
Considerations for Specific Patient Groups
- For children under 8 years old, oral tetracycline may not be suitable, and alternative treatments such as topical metronidazole or pimecrolimus may be considered 3.
- Long-term intermittent treatment with pimecrolimus cream 1% can reduce the need for topical corticosteroids in pediatric patients with mild to moderate atopic dermatitis 6.
General Guidance on Topical Corticosteroid Use
- Topical corticosteroids should be used with caution, especially on the face and in children, due to the risk of adverse effects such as atrophy, striae, and rosacea 7.
- Lower potencies and shorter durations of topical corticosteroid use are recommended for children, and correct patient application is critical to successful use 7.