Perioral Dermatitis

Essentials

• 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 ).
• Occurs in young or middle-aged women in the surroundings of the nose (picture ) or mouth; sometimes also around the eyes (periocular dermatitis; (pictures )), which can become worse especially with glucocorticoid creams (picture ).

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.
  • Tetracycline 250 mg twice daily
  • Lymecycline 150-300 mg once daily
  • 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.

Pictures