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Therapeutic Strategies

Perioral Dermatitis

Timothy Berger Bruce Wintroub

Wednesday, April 13, 2011


This form of acne is frequently related to the use of moderate-to-potent topical steroids in the affected areas. In addition to the perioral region, the periorbital area is often also affected. A rim of normal skin usually separates the lips from the affected skin of the chin and cheeks. Although it is considered by some to be related to rosacea, patients usually do not have flushing and other stigmata of rosacea. This condition affects young adult women most commonly.

Initial Steps

  1. Stop the offending topical steroid. Warn the patient that the condition will worsen after a few days to a week.
  2. Administer oral tetracycline 500 mg twice daily for 4-8 weeks, then taper off over 2-3 months.
  3. Topical anti-inflammatories such as 0.1% tacrolimus ointment or 0.1% pimecrolimus cream or a low-strength topical steroid may be used for the first 2-3 weeks to blunt the exacerbation induced by stopping the topical steroid.
  4. In mild cases, a topical antibiotic/benzoyl peroxide combination or topical metronidazole cream 1% once daily may be adequate to clear the eruption.

Alternative/Subsequent Steps

  1. Doxycycline or minocycline 100 mg once daily may be used to ease compliance and in patients intolerant but not allergic to oral tetracycline.
  2. In tetracycline-allergic patients whose lesions do not clear with topical therapy, oral erythromycin, or a second generation cephalosporin can be attempted. This is rarely required.


  1. Yeast vaginitis is a common complication of oral tetracycline therapy.
  2. Tetracyclines are contraindicated in pregnancy.
  3. Perioral dermatitis may be induced by even low-strength topical steroids. Avoidance of all topical steroids is preferred, to "weaning the patient off" by giving lower and lower strengths of topical steroids. Refractory perioral dermatitis may be the result of surreptitious intermittent use of topical steroids by the patient.
  4. Perioral dermatitis is a very responsive disorder. If the patient's lesions do not clear with the therapies outlined above, the diagnosis should be reconsidered.

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