From the Guidelines
The treatment for a perioral rash should prioritize avoiding greasy creams, manipulation of skin, and hot blow-drying, and instead focus on gentle skin care and topical treatments under the supervision of a dermatologist, as suggested by the German expert opinion in 2011 1. When evaluating a perioral rash, it is essential to consider the potential causes and avoid exacerbating factors.
- Avoiding greasy creams for basic care is recommended, as they may facilitate the development of folliculitis due to their occlusive properties 1.
- Manipulation of skin and hot blow-drying of the hair should also be avoided, as they may increase the risk of infection 1.
- Topical acne medications and topical steroidsa should be used with caution, as they may irritate and worsen the rash, and should only be used under the supervision of a dermatologist 1. For treatment, gentle skin care and topical treatments such as metronidazole 0.75% gel or topical antibiotics like mupirocin 2% ointment may be effective, depending on the cause of the rash.
- It is crucial to maintain gentle cleansing with mild, fragrance-free soap and lukewarm water, and to avoid potential irritants like toothpastes with fluoride, cinnamon flavoring, or heavy facial moisturizers.
- If the rash is due to perioral dermatitis, stopping all topical steroids and facial products, and using metronidazole 0.75% gel twice daily for 2-4 weeks may be necessary.
- For fungal causes, antifungal creams like clotrimazole 1% applied twice daily for 2 weeks are effective.
- Bacterial infections may require topical antibiotics such as mupirocin 2% ointment three times daily for 7-10 days. If the rash doesn't improve within two weeks of treatment, worsens, or is accompanied by fever or significant swelling, medical evaluation is necessary as the condition may require oral medications or different treatment approaches.
From the FDA Drug Label
Directions for itching of skin irritation, inflammation, and rashes: adults and children 2 years of age and older: apply to affected area not more than 3 to 4 times daily For external use only
The treatment for a perioral rash may involve applying hydrocortisone to the affected area not more than 3 to 4 times daily for adults and children 2 years of age and older 2.
- Key considerations:
- For children under 2 years of age, consult a doctor before applying hydrocortisone.
- Avoid contact with the eyes.
- Do not use more than directed unless told to do so by a doctor.
- Stop use and ask a doctor if the condition worsens, symptoms persist for more than 7 days or clear up and occur again within a few days 2.
From the Research
Evaluation of Perioral Rash
The evaluation of a perioral rash involves considering various treatment options, as the etiology of perioral dermatitis remains unknown 3, 4.
Treatment Options
- Oral tetracycline has been found to have the best valid evidence for treating perioral dermatitis 3, 5.
- Topical metronidazole, erythromycin, and pimecrolimus are also effective treatment choices with good evidence 3, 5.
- Topical corticosteroid use is common, but its role as a treatment or cause of perioral dermatitis remains unclear 3, 4, 6.
- "Zero therapy," which involves discontinuing the use of cosmetics and topical corticosteroids, may also be effective in some cases 5.
Special Considerations
- In children under 8 years old, oral tetracycline may not be suitable, and topical metronidazole may be a viable alternative 3, 7.
- Perioral dermatitis can occur at any age in childhood and adolescence and may be associated with topical corticosteroid use 7.
- The condition may be responsive to topical metronidazole in children and adolescents 7.