The typical patient is a young adult woman who develops an itching and burning rash about the mouth. It often extends with confluent erythema along the mesolabial fold.

PERIORAL DERMATITIS

Perioral dermatitis (PD) is a common red, papular condition about the nose and mouth of young women. A common precipitating factor is a topical steroid. The steroid may have been started because of a mild facial eczema or lip cheilitis (either of which may have resolved) or it may have been given for the perioral dermatitis. Whatever the reason, the steroid is one reason the perioral dermatitis persists. It helps the rash some but never clears it and once the patient stops, the rash flares. One should inquire about the use of steroid-containing nasal sprays as beclomethasone dipropionate nasal spray for allergic rhinitis has been associated.

• Red, papular rash common about the mouth and nose.
• Women 25-35 years of age most commonly affected.
• Often itches or burns.

Treatment

• "Zero therapy," i.e., stop any topical steroids and/or irritants.
• Doxycycline 100 mg BID
• Topical erythromycin.
• Topical pimecrolimus.

It is important to stop all topical steroids. This may cause a flare, and the patient should be warned about this. Tapering down to hydrocortisone 1% cream for 1-2 weeks may be helpful in some. The most effective therapy is tetracycline 500 mg BID, doxycycline 100 mg BID, or minocycline 50-100 mg QD-BID for 1-2 months. Usually therapy is continued until the skin is clear and then another week or so. The patient should be told that recurrences may occur and the antibiotic may be taken again if needed. Usually, only one or two recurrences occur and after that, the skin stays clear. Topical erythromycin can help clear, but is not as fast as the oral tetracyclines.

Children

• Topical pimecrolimus
• Ivermetin, topical or oral
• Metronidazole
• Oral erythromycin

For children under 9 years of age, tetracycline must be avoided. Treatment consists of abrupt cessation of any steroids, plus initiation of oral erythromycin. Complete clearing occurs in nearly all within 4-8 weeks. Alternatively, oral (single dose of 200-250 ug/kg) or topical (1%) ivermectin resulted in either complete or almost complete clearance in 14/15 children with either periorificial dermatitis or papulopustular rosacea. The only side effect was mild desquamation in 5 patients.

RegionalDerm

Who is Dr. White? | Privacy Policy | FAQs | Use of Images | Contact Dr. White