From the Guidelines
Perioral dermatitis can be effectively treated with topical photodynamic therapy using Levulan ALA and blue light, with a 92% lesion clearance rate, as shown in a split-face comparison study 1. This treatment approach is particularly notable for its high efficacy and relatively low risk of side effects, making it a viable option for patients with perioral dermatitis. The study demonstrated that Levulan ALA with blue light therapy resulted in a higher lesion clearance rate compared to clindamycin, with 92% of lesions clearing versus 81% with clindamycin 1. Some key points to consider when treating perioral dermatitis include:
- Avoiding the use of topical steroids, heavy moisturizers, and fluorinated toothpaste, as these can trigger or worsen the condition
- Implementing a gentle skincare routine with mild, fragrance-free cleansers
- Avoiding makeup around affected areas to help promote recovery
- Maintaining realistic expectations, as improvement may occur gradually over several weeks
- Recognizing that recurrence is common, and maintaining gentle skincare practices even after clearing is important for prevention It's essential to weigh the potential benefits and risks of different treatment options and consider the most recent and highest-quality evidence when making treatment decisions for perioral dermatitis 1.
From the Research
Definition and Characteristics of Perioral Dermatitis
- Perioral dermatitis is a common and often chronic dermatosis that primarily affects women aged 15 to 45 years 2.
- It 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 2, 3.
- There are variants of perioral dermatitis, including lupus-like and granulomatous perioral dermatitis, with the granulomatous form being more common in childhood and affecting mostly prepubescent boys 2.
Etiology and Pathogenesis
- The etiopathogenesis of perioral dermatitis remains unclear, but prolonged use of topical products, especially corticosteroids, is a frequent finding preceding the clinical manifestation of the disease 2, 4.
- Other causes important for the occurrence of the disease include various skin irritants, as well as other physical and hormonal factors, which all share epidermal barrier dysfunction as an underlying main pathogenic factor 2.
- Topical corticosteroid misuse is considered the principal causative factor in the pathogenesis of perioral dermatitis 4.
Treatment Options
- The therapeutic approach should be individually addressed, depending on the severity of clinical presentation and patient's age, with special attention to patient's education and continuous psychological support 2.
- In mild forms of perioral dermatitis, 'zero therapy' is the treatment of choice, which involves discontinuing the use of cosmetics and topical corticosteroids 5.
- Topical metronidazole, erythromycin, and pimecrolimus are effective treatment choices for moderate disease 2, 6, 5.
- Oral tetracycline is the best validated choice for more severe cases, and systemic isotretinoin should be considered as a therapeutic option for patients refractory to all standard therapies 2, 6, 5.