Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Perioral Dermatitis Medication

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

Medication Summary

In mild cases, as well as in most children and pregnant women, individualized topical therapy is generally recommended. Antimicrobial agents (eg, metronidazole[7, 16, 17, 18] and erythromycin) are administered in a nongreasy base (eg, gel, lotion, cream). Pimecrolimus cream significantly reduced the Perioral Dermatitis Severity Index[19] (PODSI) compared with vehicle in a randomized, double-blind study in adults.[20] Pimecrolimus cream seems to be most effective in steroid-induced perioral dermatitis.[21] Topical antiacne medications such as adapalene[22] and azelaic acid[23, 24] have been used in open studies. Ointments should be avoided.

In severe forms of perioral dermatitis, systemic treatment with antirosacea drugs is required. The drugs of choice are doxycycline (or tetracycline) and minocycline. In unresponsive and granulomatous forms, oral isotretinoin[25] may be considered. Oral erythromycin can be used in pediatric patients with more severe or refractory involvement.

Zero-therapy is based on the idea that by ceasing use of all topical medications and cosmetics, the underlying causative factor for perioral dermatitis is eliminated. This form of therapy is appropriate in very compliant patients. It may be effective predominantly in cases associated with steroid abuse or when intolerance to cosmetics is suspected.[26, 27]

In every case, an initial worsening of the symptoms may occur with treatment, especially if topical steroids are withdrawn. The patient should be made aware of this complication. In cases of preceding long-term use of topical steroids, steroid weaning with low-dose 0.1-0.5% hydrocortisone cream can be tried initially.

Next

Antibiotics, Other

Class Summary

These drugs may have antibacterial and/or anti-inflammatory effects that are responsible for their effectiveness in perioral dermatitis.

Doxycycline (Oracea, Doryx, Vibramycin)

 

Doxycycline is the drug of choice in nonpregnant women. It inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. Alternatively, one may use tetracycline in adapted dose.

Minocycline (Dynacin, Minocin, Solodyn)

 

Minocycline is believed to be the most efficacious tetracycline in dermatoses of sebaceous glands. It is used to treat infections caused by susceptible gram-negative and gram-positive organisms, in addition to infections caused by susceptible Chlamydia, Rickettsia, and Mycoplasma species.

Tetracycline

 

Tetracycline inhibits bacterial protein synthesis by binding with 30S and possibly 50S ribosomal subunits. It has anti-inflammatory activity.

Metronidazole (Flagyl)

 

Metronidazole is an imidazole ring-based antibiotic active against various anaerobic bacteria and protozoa. In concentrations of 0.75-2%, it is considered to be the drug of choice for topical treatment of perioral dermatitis. Metronidazole is available in a gel, lotion, or cream.

Erythromycin (E.E.S., Erythrocin, Ery-Tab)

 

Topical erythromycin in concentrations of 2-4% as a gel or cream is an alternative to metronidazole for topical treatment. It inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest. It is used to treat staphylococcal and streptococcal infections.

Previous
Next

Retinoid-Like Agents

Class Summary

These agents reduce the size of the sebaceous glands, decrease sebum secretion, and inhibit keratinization.

Isotretinoin (Amnesteem, Claravis, Sotret)

 

Isotretinoin is an oral agent used to treat serious dermatologic conditions. It is a synthetic 13-cis isomer of naturally occurring tretinoin (trans -retinoic acid). Both agents are structurally related to vitamin A. Isotretinoin decreases sebaceous gland size and sebum production. It may inhibit sebaceous gland differentiation and abnormal keratinization. Isotretinoin is indicated for long-standing and refractory forms of perioral dermatitis. Because of adverse effects, therapy should be prescribed only by a physician familiar with this drug (ie, dermatologist).

A US Food and Drug Administration–mandated registry is now in place for all individuals prescribing, dispensing, or taking isotretinoin. For more information on this registry, see iPLEDGE. This registry aims to further decrease the risk of pregnancy and other unwanted and potentially dangerous adverse effects during a course of isotretinoin therapy.

Previous
Next

Immunomodulators

Class Summary

Pimecrolimus cream controls atopic dermatitis.

Pimecrolimus (Elidel)

 

Pimecrolimus is the first nonsteroid cream approved in the United States for mild-to-moderate atopic dermatitis. It is derived from ascomycin, a natural substance produced by the fungus Streptomyces hygroscopicus var ascomyceticus. Pimecrolimus selectively inhibits the production and release of inflammatory cytokines from activated T-cells by binding to cytosolic immunophilin receptor macrophilin-12. The resulting complex inhibits phosphatase calcineurin, thus blocking T-cell activation and cytokine release. Cutaneous atrophy is not observed in clinical trials, a potential advantage over topical corticosteroids.

Previous
 
 
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.

References
  1. Kihiczak GG, Cruz MA, Schwartz RA. Periorificial dermatitis in children: an update and description of a child with striking features. Int J Dermatol. 2009 Mar. 48(3):304-6. [Medline].

  2. Baratli J, Megahed M. [Lupoid perioral dermatitis as a special form of perioral dermatitis : Review of pathogenesis and new therapeutic options.]. Hautarzt. 2013 Nov 9. [Medline].

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

  4. Peralta L, Morais P. Perioral dermatitis -- the role of nasal steroids. Cutan Ocul Toxicol. 2012 Jun. 31(2):160-3. [Medline].

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

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

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

  8. Maeda A, Ishiguro N, Kawashima M. The pathogenetic role of rod-shaped bacteria containing intracellular granules in the vellus hairs of a patient with perioral dermatitis: A comparison with perioral corticosteroid-induced rosacea. Australas J Dermatol. 2015 Apr 20. [Medline].

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

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

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

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

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

  14. Bribeche MR, Fedotov VP, Jillella A, Gladichev VV, Pukhalskaya DM. Topical praziquantel as a new treatment for perioral dermatitis: results of a randomized vehicle-controlled pilot study. Clin Exp Dermatol. 2014 Jun. 39 (4):448-53. [Medline].

  15. Tempark T, Shwayder TA. Perioral dermatitis: a review of the condition with special attention to treatment options. Am J Clin Dermatol. 2014 Apr. 15 (2):101-13. [Medline].

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

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

  18. 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. 2007 Oct. 21(9):1175-80. [Medline].

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

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

  21. 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. 2008 Jul. 59(1):34-40. [Medline].

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

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

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

  25. 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].

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

  27. Hall CS, Reichenberg J. Evidence based review of perioral dermatitis therapy. G Ital Dermatol Venereol. 2010 Aug. 145(4):433-44. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.