What is the treatment for perioral dermatitis?

From the Guidelines

The treatment for perioral dermatitis typically involves stopping irritating products and using appropriate medications, with topical antibiotics like metronidazole 0.75% cream or gel being effective for mild cases, and oral antibiotics like doxycycline or minocycline for moderate to severe cases. When managing perioral dermatitis, it is crucial to discontinue all topical steroids, as they may cause perioral dermatitis and skin atrophy if used inadequately 1. Key steps in treatment include:

• Discontinuing heavy facial creams and fluorinated toothpastes that can trigger or worsen the condition
• Using gentle, fragrance-free cleansers
• Avoiding heavy moisturizers, especially greasy creams that might facilitate the development of folliculitis due to their occlusive properties 1
• Considering topical antibiotics for mild cases, with metronidazole 0.75% cream or gel applied twice daily for 8-12 weeks often being effective
• Prescribing oral antibiotics, particularly tetracyclines such as doxycycline (100mg twice daily for 4-6 weeks, then tapering) or minocycline (100mg daily), for moderate to severe cases
• Using alternative treatments like erythromycin (250-500mg twice daily) for patients who cannot take tetracyclines
• Possibly using topical calcineurin inhibitors like pimecrolimus or tacrolimus in some cases Improvement typically begins within 2-4 weeks, but complete resolution may take 3 months or longer, emphasizing the need for patience and adherence to treatment to allow the skin barrier to heal and prevent relapse.

From the Research

Treatment Options for Perioral Dermatitis

The treatment for perioral dermatitis can vary depending on the severity of the condition and the patient's age.

• In mild cases, 'zero therapy' is often the treatment of choice, which involves discontinuing the use of cosmetics and topical corticosteroids 2.
• For moderate cases, treatment options include:
  • Topical metronidazole 3, 4, 5, 2, 6
  • Topical erythromycin 3, 4, 5, 2
  • Topical pimecrolimus 3, 4, 2
• In more severe cases, oral tetracycline is often the best validated choice, and should be used until complete remission is achieved 3, 4, 2.
• Systemic isotretinoin may be considered as a therapeutic option for patients who are refractory to all standard therapies 3.

Considerations for Treatment

When treating perioral dermatitis, it is essential to consider the potential for rebound phenomenon, particularly when stopping topical corticosteroid treatment 3, 4.

• Patient education and continuous psychological support are also crucial in managing the condition 3.
• The treatment approach should be individually addressed, taking into account the severity of the clinical presentation and the patient's age 3.