eMedicine Specialties > Dermatology > Diseases of the Adnexa

Perioral Dermatitis: Follow-up

Author: Hans J Kammler, MD, PhD, Head of Unit for Dermatology, ENT, Ophthalmology, and Respiratory Diseases, German Federal Institute for Drugs and Medical Devices (BfArM)
Contributor Information and Disclosures

Updated: Oct 23, 2009

Follow-up

Further Inpatient Care

  • Perioral dermatitis (POD) is almost exclusively treated on an outpatient basis.

Further Outpatient Care

  • Care includes an assessment of the effectiveness of systemic therapy.
  • Topical therapy should be adapted in accordance to the condition of the skin and the severity of the disease.

Inpatient & Outpatient Medications

  • Systemic treatment includes antiacne medications such as doxycycline, tetracycline, minocycline, and isotretinoin.
  • Topical treatment includes antibiotics such as metronidazole13 and erythromycin. Antiacne drugs such as adapalene18 and azelaic acid19,20 have been used in noncontrolled studies. Pimecrolimus, a calcineurin inhibitor used in the treatment of atopic dermatitis, has been successful in vehicle-controlled clinical trials.16,17
  • The use of potent topical steroids is strictly contraindicated. However, in some cases, the initial use of a low-potency corticosteroid (eg, hydrocortisone cream) may be appropriate.
  • The use of cosmetics, cleansers, and moisturizers should be avoided during treatment.

Deterrence/Prevention

  • If provoking factors can be determined, they should be avoided.

Complications

  • Although perioral dermatitis is limited to the skin and not life threatening, emotional problems may occur because of the disfiguring character of the facial lesions and the possibly prolonged course of the disease.
  • An initial rebound effect frequently occurs during the weaning of the steroid. This phenomenon is rare when no underlying cause can be evaluated.
  • A chronic course is not uncommon.
  • The development of a lupoid dermal infiltrate is considered to be a feature of the maximal variant of the disease.
    • The diagnosis is made on the basis of the yellowish discoloration after diascopy.
    • This entity is called lupuslike perioral dermatitis.
  • Scarring may be a problem with the lupoid form of perioral dermatitis.

Prognosis

  • Perioral dermatitis is not a life-threatening disease.
  • However, unexpectedly long period of treatment may be required to achieve a cosmetically satisfactory skin condition.

Patient Education

  • Reassurance and education about possible underlying factors and the time course of the disease are critical. These measures help the patient to cope with the disfiguring character of the disease and help to minimize the risk of recurrences.
  • Patients have to be aware that initial deterioration may occur, especially if they previously used a topical steroid.
  • The use of all topical preparations, including cosmetics, should be avoided except the prescribed medication.
  • The patient should be advised that remission might not occur for weeks, despite correct treatment.

Miscellaneous

Medicolegal Pitfalls

  • Failure to inform the patient about a possible rebound at the initiation of therapy
  • Prescribing potent topical steroids

Special Concerns

  • In pediatric patients, as well as pregnant women, only topical therapy should be administered because systemic drugs may be contraindicated.
 


More on Perioral Dermatitis

Overview: Perioral Dermatitis
Differential Diagnoses & Workup: Perioral Dermatitis
Treatment & Medication: Perioral Dermatitis
Follow-up: Perioral Dermatitis
References
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References

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  2. Chen AY, Zirwas MJ. Steroid-induced rosacealike dermatitis: case report and review of the literature. Cutis. Apr 2009;83(4):198-204. [Medline].

  3. Beacham BE, Kurgansky D, Gould WM. Circumoral dermatitis and cheilitis caused by tartar control dentifrices. J Am Acad Dermatol. Jun 1990;22(6 Pt 1):1029-32. [Medline].

  4. Karincaoglu Y, Bayram N, Aycan O, Esrefoglu M. The clinical importance of demodex folliculorum presenting with nonspecific facial signs and symptoms. J Dermatol. Aug 2004;31(8):618-26. [Medline].

  5. Abeck D, Geisenfelder B, Brandt O. Physical sunscreens with high sun protection factor may cause perioral dermatitis in children. J Dtsch Dermatol Ges. Aug 2009;7(8):701-3. [Medline].

  6. Antille C, Saurat JH, Lübbe J. Induction of rosaceiform dermatitis during treatment of facial inflammatory dermatoses with tacrolimus ointment. Arch Dermatol. Apr 2004;140(4):457-60. [Medline].

  7. Dirschka T, Tronnier H, Folster-Holst R. Epithelial barrier function and atopic diathesis in rosacea and perioral dermatitis. Br J Dermatol. Jun 2004;150(6):1136-41. [Medline].

  8. Lucas CR, Korman NJ, Gilliam AC. Granulomatous periorificial dermatitis: a variant of granulomatous rosacea in children?. J Cutan Med Surg. Mar-Apr 2009;13(2):115-8. [Medline].

  9. Richey DF, Hopson B. Photodynamic therapy for perioral dermatitis. J Drugs Dermatol. Feb 2006;5(2 Suppl):12-6. [Medline].

  10. Smith KW. Perioral dermatitis with histopathologic features of granulomatous rosacea: successful treatment with isotretinoin. Cutis. Nov 1990;46(5):413-5. [Medline].

  11. Boeck K, Abeck D, Werfel S, Ring J. Perioral dermatitis in children--clinical presentation, pathogenesis-related factors and response to topical metronidazole. Dermatology. 1997;195(3):235-8. [Medline].

  12. Miller SR, Shalita AR. Topical metronidazole gel (0.75%) for the treatment of perioral dermatitis in children. J Am Acad Dermatol. Nov 1994;31(5 Pt 2):847-8. [Medline].

  13. Wollenberg A, Oppel T. Scoring of skin lesions with the perioral dermatitis severity index (PODSI). Acta Derm Venereol. 2006;86(3):251-2. [Medline].

  14. Oppel T, Pavicic T, Kamann S, Bräutigam M, Wollenberg A. Pimecrolimus cream (1%) efficacy in perioral dermatitis - results of a randomized, double-blind, vehicle-controlled study in 40 patients. J Eur Acad Dermatol Venereol. Oct 2007;21(9):1175-80. [Medline].

  15. Jansen T. Perioral dermatitis successfully treated with topical adapalene. J Eur Acad Dermatol Venereol. Mar 2002;16(2):175-7. [Medline].

  16. Jansen T. Azelaic acid as a new treatment for perioral dermatitis: results from an open study. Br J Dermatol. Oct 2004;151(4):933-4. [Medline].

  17. Schwarz T, Kreiselmaier I, Bieber T, et al. A randomized, double-blind, vehicle-controlled study of 1% pimecrolimus cream in adult patients with perioral dermatitis. J Am Acad Dermatol. Jul 2008;59(1):34-40. [Medline].

  18. Del Rosso JQ. The use of topical azelaic acid for common skin disorders other than inflammatory rosacea. Cutis. Feb 2006;77(2 Suppl):22-4. [Medline].

  19. Hafeez ZH. Perioral dermatitis: an update. Int J Dermatol. Jul 2003;42(7):514-7. [Medline].

  20. Katsambas AD, Nicolaidou E. Acne, perioral dermatitis, flushing, and rosacea: unapproved treatments or indications. Clin Dermatol. Mar-Apr 2000;18(2):171-6. [Medline].

  21. Hengge UR, Ruzicka T, Schwartz RA, Cork MJ. Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol. Jan 2006;54(1):1-15; quiz 16-8. [Medline].

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  23. Kuflik JH, Janniger CK, Piela Z. Perioral dermatitis: an acneiform eruption. Cutis. Jan 2001;67(1):21-2. [Medline].

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  26. Malik R, Quirk CJ. Topical applications and perioral dermatitis. Australas J Dermatol. Feb 2000;41(1):34-8. [Medline].

  27. Nguyen V, Eichenfield LF. Periorificial dermatitis in children and adolescents. J Am Acad Dermatol. Nov 2006;55(5):781-5. [Medline].

  28. Takiwaki H, Tsuda H, Arase S, Takeichi H. Differences between intrafollicular microorganism profiles in perioral and seborrhoeic dermatitis. Clin Exp Dermatol. Sep 2003;28(5):531-4. [Medline].

  29. Tarm K, Creel NB, Krivda SJ, Turiansky GW. Granulomatous periorificial dermatitis. Cutis. Jun 2004;73(6):399-402. [Medline].

  30. Urbatsch AJ, Frieden I, Williams ML, Elewski BE, Mancini AJ, Paller AS. Extrafacial and generalized granulomatous periorificial dermatitis. Arch Dermatol. Oct 2002;138(10):1354-8. [Medline].

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Further Reading

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Keywords

perioral dermatitis, POD, rosacealike dermatitis, periorificial dermatitis, light-sensitive seborrheid, chronic papulopustular facial dermatitis, papulopustular facial dermatitis, granulomatous perioral dermatitis, lupuslike perioral dermatitis

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Contributor Information and Disclosures

Author

Hans J Kammler, MD, PhD, Head of Unit for Dermatology, ENT, Ophthalmology, and Respiratory Diseases, German Federal Institute for Drugs and Medical Devices (BfArM)
Disclosure: Nothing to disclose.

Medical Editor

James Fulton Jr, MD, PhD, Center for Cosmetic Dermatology; Consultant, Vivant Pharmaceuticals, LLC
James Fulton Jr, MD, PhD is a member of the following medical societies: American Academy of Cosmetic Surgery, American Academy of Dermatology, American Society for Laser Medicine and Surgery, Dermatology Foundation, International Society of Cosmetic and Laser Surgeons, and Skin Cancer Foundation
Disclosure: vivant pharmaceuticals Ownership interest Consulting

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey Meffert, MD, Assistant Clinical Professor of Dermatology, University of Texas Health Science Center-San Antonio
Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society
Disclosure: Nothing to disclose.

CME Editor

Catherine M Quirk, MD, Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania
Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

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