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 metronidazole being a common first-line treatment. To manage perioral dermatitis, it is essential to discontinue all topical steroids, as they may cause perioral dermatitis and skin atrophy if used inadequately 1. Heavy facial creams and potentially irritating cosmetics should also be avoided, as greasy creams might facilitate the development of folliculitis due to their occlusive properties 1.

Key Treatment Steps

• Use a gentle, fragrance-free cleanser
• Avoid fluorinated toothpastes
• Apply topical metronidazole (0.75% or 1% cream or gel) twice daily for 8-12 weeks as a first-line treatment
• Alternatively, use topical azelaic acid (15-20%) or topical clindamycin (1%)
• For moderate to severe cases, consider oral antibiotics like doxycycline (100mg twice daily) or minocycline (100mg twice daily) for 4-8 weeks

It's crucial to note that perioral dermatitis is believed to be an inflammatory disorder with possible microbial components, which explains why both anti-inflammatory and antimicrobial treatments are effective. Improvement typically begins within 2-4 weeks, but complete resolution may take several months 1. The condition can recur, so gradual tapering of medications is recommended.

From the FDA Drug Label

To use AZELEX® Cream for the full prescribed treatment period. If troublesome irritation persists, use should be discontinued, and patients should consult their physician.

The treatment for perioral dermatitis may include the use of azelaic acid (TOP), as it is commonly used to treat this condition. However, the specific treatment should be determined by a physician, and patients should follow their prescribed treatment plan.

• Patients should use the cream as directed by their physician.
• They should avoid applying the cream to broken or inflamed skin, and temporary skin irritation may occur.
• If irritation persists, patients should consult their physician 2.

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. Some of the treatment options include:

• 'Zero therapy' for mild forms of perioral dermatitis, which involves stopping the use of all topical products 3
• Topical metronidazole, erythromycin, and pimecrolimus for moderate disease 3, 4, 5
• Oral tetracycline in a subantimicrobial dose for more severe cases 3, 4, 5
• Systemic isotretinoin for patients who are refractory to all standard therapies 3
• Azelaic acid cream, benzyl peroxide preparations, and topical clindamycin or tetracycline may also be used 4
• Discontinuing topical fluorinated corticosteroid use and using topical metronidazole alone or in combination with oral tetracycline or erythromycin for children 6

Considerations for Treatment

When treating perioral dermatitis, it is essential to consider the following:

• The patient's age, as some treatments may not be suitable for children under a certain age 5, 6
• The severity of the condition, as more severe cases may require oral antibiotics or other systemic treatments 3, 4, 5
• The potential for rebound phenomenon when stopping topical corticosteroid use 3, 6
• The importance of repairing the impaired skin barrier function to minimize skin inflammation and sensitivity 7