Would retinoids (retinoic acid) help or irritate perioral dermatitis?

Retinoids Should Be Avoided in Perioral Dermatitis

Retinoids should be avoided in perioral dermatitis as they may irritate and worsen the condition rather than help it. 1

Mechanism of Irritation

• Topical retinoids can be irritating to the skin, particularly in sensitive areas like the perioral region, causing increased dryness, erythema, and potential exacerbation of perioral dermatitis 1
• Retinoids may aggravate xerosis (skin dryness) and increase itch sensation, which can worsen the symptoms of perioral dermatitis 1
• Both topical and systemic retinoids can disrupt the skin barrier, which is already compromised in perioral dermatitis 1

Evidence Against Retinoid Use

• Guidelines specifically list topical retinoids among treatments that should be avoided in perioral dermatitis due to their drying and irritating effects 1
• Topical acne medications, including retinoids, may worsen anti-EGFR-induced skin rash due to their drying effects, and this principle extends to perioral dermatitis 1
• Topical steroids are known to cause perioral dermatitis, and retinoids can have similar irritating effects on the sensitive perioral skin 1

Recommended Treatments Instead

• "Zero therapy" - discontinuation of all potential irritants including cosmetics and topical corticosteroids is considered first-line management 2
• Oral tetracyclines (for patients over 8 years old) are the most evidence-supported treatment for perioral dermatitis 3, 2
• Topical options with good evidence include:
  • Metronidazole 3, 4
  • Erythromycin 3, 2
  • Pimecrolimus (particularly if prior corticosteroid use has occurred) 3, 2

Special Considerations

• For children under 8 years old, oral tetracyclines should be avoided, and topical treatments like metronidazole or erythromycin are preferred 3, 4
• Perioral dermatitis is often self-limited if potential exacerbating factors are removed 2
• Moisturizing with non-comedogenic, hypoallergenic products may help repair the skin barrier without causing further irritation 1

Rare Exceptions

• In extremely recalcitrant cases of granulomatous periorificial dermatitis (a variant), low-dose oral isotretinoin has been reported to be effective, but this should only be considered under dermatologist supervision after other treatments have failed 5
• Individual patients with specific variants of dermatitis may occasionally benefit from topical adapalene (a synthetic retinoid with lower irritation potential), but only under strict dermatologist supervision 1

Prevention of Irritation

• If retinoids are being used for other conditions, irritation can be minimized through:
  • Encapsulating retinoids or using nanoparticle formulations 6
  • Adding ingredients with anti-irritation activity 6
  • Improving skin barrier function and hydration 6
• However, even with these modifications, retinoids should generally be avoided in the perioral region in patients with perioral dermatitis 1