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Editors

PekkaAutio

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.
  • 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

    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]