From the Guidelines
The treatment for perioral dermatitis involves stopping irritating products and using appropriate medications, with topical antibiotics like metronidazole or oral antibiotics such as doxycycline being effective options. The first step is to discontinue all topical steroids, heavy facial creams, and fluorinated toothpastes which can trigger or worsen the condition 1. For mild cases, topical antibiotics like metronidazole 0.75% cream or gel applied twice daily for 8-12 weeks is often effective.
Key Considerations
- Discontinue topical steroids, as they may cause perioral dermatitis and skin atrophy if used inadequately 1
- Avoid greasy creams for basic care, as they might facilitate the development of folliculitis due to their occlusive properties 1
- Topical retinoids may be irritating, and systemic retinoids may aggravate xerosis and increase itch sensation, so their use should be supervised by a dermatologist 1
Treatment Options
- Topical antibiotics: metronidazole 0.75% cream or gel applied twice daily for 8-12 weeks
- Oral antibiotics: doxycycline (100mg twice daily for 4-6 weeks, then tapering) or minocycline (100mg daily)
- Alternative for patients who cannot take tetracyclines: erythromycin (250-500mg twice daily)
- Topical calcineurin inhibitors: pimecrolimus or tacrolimus may be used in some cases
Additional Recommendations
- Use gentle, fragrance-free cleansers and avoid heavy moisturizers during treatment
- Improvement typically begins within 2-4 weeks, but complete resolution may take 3 months or longer
- Patience is important as the skin barrier needs time to heal, and premature discontinuation of treatment may lead to recurrence
From the Research
Treatment Options for Perioral Dermatitis
The treatment for perioral dermatitis may involve various approaches, including:
- Topical metronidazole, which has been found to be effective in some cases 2, 3, 4
- Azelaic acid cream, which can be used as an alternative treatment option 2, 5
- Benzyl peroxide preparations, which may be helpful in reducing inflammation 2
- Topical erythromycin, clindamycin, or tetracycline, which can be used to treat perioral dermatitis, especially in cases that are more resistant 2, 6
- Oral tetracycline, doxycycline, or minocycline, which may be prescribed for more severe cases or for patients who do not respond to topical treatments 2, 3, 6, 4
- Discontinuation of topical fluorinated corticosteroid use, which is often recommended as a first step in treating perioral dermatitis, especially in children 3, 4
- "Zero therapy," which involves discontinuing the use of cosmetics and topical corticosteroids, and may be effective in self-limited cases 6
- Topical pimecrolimus, which has been found to rapidly reduce the severity of the disease, particularly in cases where prior corticosteroid use has occurred 6
- Adapalene gel and oral isotretinoin, which have been suggested as potential treatment options, but require further research to confirm their efficacy 5