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.
- Stop the offending topical steroid. Warn the patient that the
condition will worsen after a few days to a week.
- Administer oral tetracycline 500 mg twice daily for 4-8 weeks,
then taper off over 2-3 months.
- 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.
- In mild cases, a topical antibiotic/benzoyl peroxide
combination or topical metronidazole cream 1% once daily may be
adequate to clear the eruption.
- Doxycycline or minocycline 100 mg once daily may be used to
ease compliance and in patients intolerant but not allergic to oral
- 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.
- Yeast vaginitis is a common complication of oral tetracycline
- Tetracyclines are contraindicated in pregnancy.
- 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
- 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.