Oral Tetracycline, Topical Metronidazole, and Topical Erythromycin in the Treatment of Perioral Dermatitis

In a randomized prospective therapeutic study, 33 patients with perioral dermatitis received a topical erythromycin preparation, 35 received oral tetracycline and 31 received placebo 1. The treatment response was evaluated by papule count. Oral tetracycline and the topical erythromycin preparation were superior to placebo in achieving a satisfactory therapeutic response (0 to 10 remaining papules) (P < 0.001) and in reducing the number of papules observed at several follow-up visits starting on day 20. The topical erythromycin preparation performed similarly to oral tetracycline.

The twice-daily topical application of 1% metronidazole cream was compared with 250 mg oral tetracycline, taken twice daily, in the treatment of perioral dermatitis in a prospective, double-blind, double-dummy, randomized, multicentre trial in 108 patients treated for 8 weeks 2. The median number of papules in the metronidazole-treated group was reduced to 8% of the initial number, and the median number in the group treated with tetracycline was reduced to 0% of the initial number. Although both treatments were effective, oral tetracycline was significantly more effective than topical metronidazole.

Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison).

References

• Weber K, Thurmayr R, Meisinger A. A topical erythromycin preparation and oral tetracycline for the treatment of perioral dermatitis: A placebo-controlled trial. J Dermatol Treat 1993;4:57-59.
• Veien NK, Munkvad JM, Nielsen AO, Niordson AM, Stahl D, Thormann J. Topical metronidazole in the treatment of perioral dermatitis. J Am Acad Dermatol 1991 Feb;24(2 Pt 1):258-60. [PubMed]