A disease of unknown aetiology mostly affecting women
Cosmetics and local glucocorticoids on the face have been suspected as causative agents.
Mild symptoms may be treated with topical treatments. Antimicrobials of the tetracyclines group are used as systemic medication.
Clinical features
Small erythematous papules and single small pustules, but no comedones or scars (pictures 1234).
Occurs in young or middle-aged women in the surroundings of the nose (picture 5) or mouth; sometimes also around the eyes (periocular dermatitis; (pictures 678)), which can become worse especially with glucocorticoid creams (picture 9).
Investigations
No diagnostic tests are available.
Treatment
If the patient is using topical glucocorticoids on the face, the drug is discontinued, gradually if possible. Too rapid discontinuation may cause exacerbation of symptoms.
In mild cases, topical treatment may suffice.
A metronidazole cream or gel 1-2 times daily for 3-4 months
Pimecrolimus cream 1-2 times daily for 1-2 months (not an official indication)
Azelaic acid twice daily for at least 4 weeks, and longer if required
Ivermectin once daily for no longer than 4 months.
Primarily drugs in the tetracyclines group are used as systemic medication. Treatment duration varies between 4 and 16 weeks.
Doxycycline 40 mg once daily (or 100 mg once daily)
If tetracyclines cannot be used, erythromycin can be used as an alternative, 250 mg twice daily or 500 mg once daily, treatment duration as above.
References
Tempark T, Shwayder TA. Perioral dermatitis: a review of the condition with special attention to treatment options. Am J Clin Dermatol 2014;15(2):101-13. [PubMed]
Schwarz T, Kreiselmaier I, Bieber T ym. A randomized, double-blind, vehicle-controlled study of 1% pimecrolimus cream in adult patients with perioral dermatitis. J Am Acad Dermatol 2008;59(1):34-40. [PubMed]