By Gary M. White, MD
Granulomatous periorificial dermatitis is a benign inflammatory condition that tends to occur about the eyes and mouth of darker-skinned patients. It is akin to either granulomatous rosacea or perioral dermatitis. The term FACE has been used (Facial Afro-Caribbean Childhood Eruption). Patients tend to be between 3 and 11 years of age.
Multiple, symmetric 1-3 mm, flesh-colored papules occur about the eyes and mouth. Children are commonly affected.
One should exclude any topical steroid use. Inhaled steroids for lung disease using a mask has induced facial acne in children and should be ruled out here. Therapy is often not effective although the condition usually spontaneously remits within a year. Topical metronidazole (e.g., Metrogel, Noritate) and/or oral erythromycin over 2 months may be tried. Adolescents may be treated with oral tetracyclines, e.g., doxycycline. This may be combined with topical ivermectin (Soolantra), metronidazole, or azelaic acid 20% [Indian J Dermatol. 2015 May-Jun; 60(3): 323]. Clarithromycin 250 mg/day initially then tapered was effective in two patients with granulomatous perioral dermatitis.
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