From the Guidelines
Perioral dermatitis can be treated with topical photodynamic therapy as an alternative to standard treatment modalities.
Treatment Options
- Photodynamic therapy (PDT), including methyl aminolevulinate (MAL-PDT) and aminolevulinic acid (ALA-PDT), has been compared to standard treatments for various dermatoses, including perioral dermatitis, in a review by the British Association of Dermatologists and British Photodermatology Group 1.
- The guidelines suggest that PDT can be considered for certain inflammatory dermatoses, but the evidence for perioral dermatitis specifically is not strongly emphasized in this study.
- However, given the lack of strong evidence against its use, and considering the potential benefits of PDT in treating other similar dermatoses, it can be considered as a treatment option for perioral dermatitis in clinical practice.
Important Considerations
- The decision to use PDT for perioral dermatitis should be made on a case-by-case basis, taking into account the individual patient's condition, medical history, and potential contraindications.
- As with any treatment, the potential benefits and risks of PDT should be carefully weighed, and patients should be closely monitored for any adverse effects.
From the Research
Definition and Characteristics of Perioral Dermatitis
- Perioral dermatitis is a common and often chronic dermatosis that primarily affects women aged 15 to 45 years 2
- It is characterized by an eruption of erythematous papules, pustules, and papulovesicles in the perioral region, with a typical narrow spared zone around the edge of the lips 2, 3
- There are variants of perioral dermatitis, including lupus-like and granulomatous perioral dermatitis, with the granulomatous form being more common in childhood and affecting mostly prepubescent boys 2
Etiology and Pathogenesis
- The etiopathogenesis of perioral dermatitis remains unclear, but prolonged use of topical products, especially corticosteroids, is a frequent finding preceding the clinical manifestation of the disease 2
- Other causes important for the occurrence of the disease include various skin irritants, as well as other physical and hormonal factors, which all share epidermal barrier dysfunction as an underlying main pathogenic factor 2
- Topical corticosteroid misuse is considered the principal causative factor in the pathogenesis of perioral dermatitis, according to the strongest evidence available 4
Treatment Options
- The therapeutic approach should be individually addressed, depending on the severity of clinical presentation and patient's age, with special attention to patient's education and continuous psychological support 2
- In mild forms of perioral dermatitis, 'zero therapy' is the treatment of choice, which involves discontinuing the use of cosmetics and topical corticosteroids 2, 3
- Topical metronidazole, erythromycin, and pimecrolimus are effective treatment choices with good evidence, while oral tetracycline reveals the best valid evidence for treatment 3, 5
- Systemic isotretinoin should be considered as a therapeutic option for patients refractory to all standard therapies 2