Editors

PekkaAutio

Perioral Dermatitis

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.

Small erythematous papules and single small pustules, but no comedones or scars (pictures 1 2 3 4).
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 6 7 8)), which can become worse especially with glucocorticoid creams (picture 9).

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.

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]