From the Guidelines
The recommended treatment for perioral dermatitis involves discontinuing all topical steroids and heavy facial creams, and using topical antibiotics such as metronidazole 0.75% or 1% cream, applied twice daily for 8-12 weeks, as first-line therapy. This approach is based on the principle of avoiding treatments that can exacerbate the condition, such as greasy creams and topical steroids, which can cause perioral dermatitis and skin atrophy if used inadequately 1.
When considering treatment options, it's essential to prioritize approaches that minimize the risk of worsening the condition. Key principles include:
- Avoiding greasy creams for basic care, as they might facilitate the development of folliculitis due to their occlusive properties 1
- Refraining from manipulation of the skin to reduce the risk of infection 1
- Avoiding hot blow-drying of the hair, wearing of tight shoes, and other irritants 1
- Being cautious with topical acne medications and topical steroids, as they may irritate and worsen the condition, and should only be used under the supervision of a dermatologist 1
For moderate to severe cases of perioral dermatitis, oral antibiotics may be prescribed, with tetracyclines being a preferred choice due to their antimicrobial and anti-inflammatory properties. However, the specific choice of antibiotic should be guided by the most recent and highest quality evidence available, considering factors such as efficacy, safety, and potential side effects.
In the context of perioral dermatitis treatment, adopting a gentle skincare routine is also crucial, including the use of mild, fragrance-free cleansers and avoiding potential irritants. Improvement typically begins within 4-8 weeks, but complete resolution may take several months. After clinical improvement, treatments should be tapered gradually to prevent relapse.
From the Research
Treatment Options for Perioral Dermatitis
The recommended treatment for perioral dermatitis includes:
- Discontinuing the use of topical fluorinated corticosteroids and cosmetics, also known as "zero therapy" 2
- Oral tetracyclines, which have been considered the first line treatment for years and significantly shorten the time to papule resolution 2, 3
- Topical erythromycin, which reduces the time to resolution, but not as quickly as oral tetracyclines 2
- Topical pimecrolimus, which rapidly reduces the severity of the disease, particularly if prior corticosteroid use has occurred 2
- Topical metronidazole, which is frequently used to treat perioral dermatitis in children, although the evidence supporting its use is relatively weak 2, 4, 3
- β-lactam antibiotics, which may be a useful treatment for perioral dermatitis, especially in cases where tetracyclines cannot be used 5
- Topical calcineurin inhibitors and topical/oral metronidazole, which have been shown to be effective treatment options for pediatric periorificial dermatitis 6
Considerations for Treatment
When treating perioral dermatitis, it is essential to consider the following:
- The age of the patient, as some treatments may be more suitable for children or adults 4, 5, 6
- The presence of systemic symptoms, which are typically absent in perioral dermatitis 4
- The use of topical corticosteroids, which can exacerbate the condition 2, 4
- The potential side effects of treatments, such as those associated with oral tetracyclines 5