From the Guidelines
Perioral dermatitis should be treated by avoiding topical steroidsa, greasy creams, and manipulation of the skin, as these can exacerbate the condition, and instead, using gentle skincare routines and considering oral antibiotics like doxycycline for moderate to severe cases. The treatment of perioral dermatitis involves a comprehensive approach to avoid irritants and promote skin healing. According to the study 1, topical steroidsa should be avoided as they may cause perioral dermatitis and skin atrophy if used inadequately. Some key considerations for managing perioral dermatitis 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, as this poses a risk of infection 1
- Considering oral antibiotics like doxycycline for moderate to severe cases, although there is no evidence-based preference for any particular antibiotic for treatment of anti-EGFR-induced skin rash grade ‡ 2 1
- Maintaining a gentle skincare routine with mild, fragrance-free cleansers and avoiding makeup around affected areas to promote recovery
- Recognizing that perioral dermatitis may be triggered by factors like topical steroid use, cosmetics, and hormonal changes, and addressing these underlying causes is crucial for effective management.
From the Research
Definition and Characteristics of Periorificial Dermatitis
- Periorificial dermatitis is a common acneiform facial eruption found in both adults and children, with variants including perioral and granulomatous periorificial dermatitis 2.
- It typically presents with erythematous to flesh-colored papules and rarely pustules near the eyes, nose, and mouth 3.
- The etiology of perioral dermatitis remains unknown, but topical corticosteroid use on the face commonly precedes the manifestation of this condition 2, 4.
Treatment Options for Periorificial Dermatitis
- Oral tetracycline has been shown to be an effective treatment option, but may not be suitable for patients under 8 years old 2, 5.
- Topical metronidazole, erythromycin, and pimecrolimus also represent effective treatment choices with good evidence 2, 5.
- Topical corticosteroid use is common in these cases, but the question of whether it is a good treatment or a cause remains unanswered 2, 4.
- Topical calcineurin inhibitors and topical/oral metronidazole have also been shown to be effective treatment options, particularly in pediatric patients 6.
Diagnosis and Management
- Diagnosis of periorificial dermatitis is clinical, and laboratory tests are not helpful in making the diagnosis 3.
- It is important to rule out other acneform diagnoses based on the age of the patient, clinical history, and presentation of the lesions 3.
- A treatment algorithm can be used to assist dermatologists, pediatric dermatologists, and general practitioners in managing this condition 2.