Perioral Dermatitis Follow-up

  • Author: Hans J Kammler, MD, PhD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Mar 9, 2011
 

Further Inpatient Care

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

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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.

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Inpatient & Outpatient Medications

Systemic treatment includes antiacne medications such as doxycycline, tetracycline, minocycline, and isotretinoin.

Topical treatment includes antibiotics such as metronidazole[14] and erythromycin. Antiacne drugs such as adapalene[19] and azelaic acid[20, 21] 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.[17, 18]

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.

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Deterrence/Prevention

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

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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.

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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.

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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.

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Contributor Information and Disclosures
Author

Hans J Kammler, MD, PhD  Head of Licensing Unit for Dermatology, ENT, Ophthalmology, and Respiratory System, German Federal Institute for Drugs and Medical Devices (BfArM)

Disclosure: Nothing to disclose.

Specialty Editor Board

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 Grant/research funds Consulting

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster 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.

Jeffrey Meffert, MD  Assistant Clinical Professor of Dermatology, University of Texas School of Medicine at 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.

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.

References

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  15. Oppel T, Pavicic T, Kamann S, Brautigam 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].

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

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