What is the treatment for perioral dermatitis?

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. When managing perioral dermatitis, it is crucial 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, clindamycin 1% solution, or erythromycin 2% solution applied twice daily for 8-12 weeks are effective. For moderate to severe cases, oral antibiotics are recommended, particularly tetracyclines such as doxycycline (100mg twice daily for 2-4 weeks, then tapering) or minocycline (100mg daily) 1. Some key points to consider in the treatment of perioral dermatitis include:

• Avoiding greasy creams for basic care, as they might facilitate the development of folliculitis due to their occlusive properties 1
• Avoiding manipulation of skin and hot blow-drying of the hair, as these can exacerbate the condition 1
• Using gentle, fragrance-free cleansers and avoiding heavy moisturizers during treatment
• Considering topical calcineurin inhibitors like tacrolimus 0.1% or pimecrolimus 1% cream for resistant cases Improvement typically begins within 4-8 weeks, but complete resolution may take several months 1. These treatments work by reducing inflammation and controlling bacterial factors that contribute to the condition, thus improving morbidity, mortality, and quality of life for patients with perioral dermatitis.

From the FDA Drug Label

Apply a thin film of Clindamycin phosphate topical solution USP, 1% twice daily to affected area. Apply a thin layer to entire affected areas after washing. Use morning and evening or as directed by physician. The treatment for perioral dermatitis may include:

• Topical antibiotics such as clindamycin phosphate topical solution USP, 1% applied twice daily to the affected area 2
• Topical metronidazole applied morning and evening or as directed by a physician 3 Key points:
• Apply a thin layer or film to the affected area
• Use twice daily, morning and evening, or as directed by a physician
• Avoid application close to the eyes

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', which involves discontinuing the use of topical products, especially corticosteroids, and is often recommended for mild cases of perioral dermatitis 4, 5
• Topical metronidazole, erythromycin, and pimecrolimus, which can be effective in treating moderate cases of perioral dermatitis 4, 6, 5
• Oral tetracycline, which is often used to treat more severe cases of perioral dermatitis and has been shown to be effective in reducing the time to papule resolution 6, 5
• Systemic isotretinoin, which can be considered as a therapeutic option for patients who are refractory to standard therapies 4

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 6, 7
• The severity of the condition, as more severe cases may require oral antibiotics or other systemic treatments 4, 6
• The potential for rebound phenomenon after cessation of topical corticosteroid treatment, which can worsen the condition 4, 6
• The importance of patient education and continuous psychological support, as perioral dermatitis can be a chronic and frustrating condition to manage 4