Perioral Dermatitis Follow-up
- Author: Hans J Kammler, MD, PhD; Chief Editor: William D James, MD more...
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.
Further Inpatient Care
Perioral dermatitis (POD) is treated on an outpatient basis.
Inpatient & Outpatient Medications
Systemic treatment includes antirosacea medications such as doxycycline, tetracycline, minocycline, and isotretinoin.
Topical treatment includes antibiotics such as metronidazole and erythromycin. Antiacne drugs such as adapalene and azelaic acid[23, 24] 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.[20, 21]
The use of potent topical steroids is strictly contraindicated. However, in some cases, the initial tapering use of a low-potency corticosteroid (eg, hydrocortisone cream) may be appropriate.
The use of cosmetics, cleansers, and moisturizers should be avoided during treatment.
If provoking factors can be determined, they should be avoided.
Although perioral dermatitis (POD) is limited to the skin and not life threatening, emotional problems may occur because of the 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.
Perioral dermatitis (POD) is not a life-threatening disease. However, unexpectedly long period of treatment may be required to achieve a cosmetically satisfactory skin condition.
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 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 many weeks, despite correct treatment.
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