Periorificial Dermatitis

Periorificial dermatitis, also called periorificial dermatitis, is an idiopathic acneiform eruption that typically occurs in children.

The etiology is not known but patients report a preceding use of topical, inhaled, or systemic corticosteroids.
Given the histologic similarities to rosacea, some consider periorificial dermatitis a childhood form of rosacea.

Grouped, acneiform, tiny erythematous papules and pustules distributed in the perioral, periocular, and intranasal areas (Fig. 3.5A).
In girls, similar lesions on the vulvar skin can be seen (Fig. 3.5B).
Resolving papules and pustules may be replaced by redness or red desquamative scale.
Eruption can be subtle and localized to one small area of the face or be extensive (Figs. 3.6-3.8).
Some patients complain of associated itching or burning especially if creams or hot water is applied to the eruption.

Differential Diagnosis

Acne

Irritant Dermatitis

Management

The condition is usually self-limiting but it can take months to years to resolve.
If triggered by use of topical or inhaled corticosteroids, discontinuation of use can lead to improvement in condition.
Topical antibiotics are first line for mild localized cases. Metrocream 1%, or erythromycin 2% gel applied twice daily can lead to resolution in mild cases.
Protopic 0.03% ointment or Elidel 1% cream have also been successfully used but there are occasional reports of exacerbation of the condition from their use.
Oral antibiotics such as erythromycin, azithromycin, or tetracyclines in patients >8 years old are used for extensive and recalcitrant cases. Antibiotics should be used for at least 6 weeks and then gradually tapered to avoid rebound flares.

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