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Perioral Dermatitis Follow-up

  • Author: Hans J Kammler, MD, PhD; Chief Editor: William D James, MD  more...
 
Updated: Feb 29, 2016
 

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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Further Inpatient Care

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

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Inpatient & Outpatient Medications

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

Topical treatment includes antibiotics such as metronidazole[17] and erythromycin. Antiacne drugs such as adapalene[22] 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.

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Deterrence/Prevention

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

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Complications

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.

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Prognosis

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.

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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 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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Contributor Information and Disclosures
Author

Hans J Kammler, MD, PhD Director and Professor, University Medical Center Bonn, Germany

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Jeffrey Meffert, MD Associate 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, Texas Dermatological Society

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Andrea Leigh Zaenglein, MD Professor of Dermatology and Pediatrics, Department of Dermatology, Hershey Medical Center, Pennsylvania State University College of Medicine

Andrea Leigh Zaenglein, MD is a member of the following medical societies: American Academy of Dermatology, Society for Pediatric Dermatology

Disclosure: Received consulting fee from Galderma for consulting; Received consulting fee from Valeant for consulting; Received consulting fee from Promius for consulting; Received consulting fee from Anacor for consulting; Received grant/research funds from Stiefel for investigator; Received grant/research funds from Astellas for investigator; Received grant/research funds from Ranbaxy for other; Received consulting fee from Ranbaxy for consulting.

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