Management of perioral dermatitis

POD: perioral dermatitis.

* "Zero therapy" refers to the discontinuation of topical corticosteroids and avoidance of skin care products and cosmetics that may irritate the skin. Efficacy of "zero therapy" can be assessed after two to three months. Refer to UpToDate topics on perioral (periorificial) dermatitis for additional details.

¶ POD may improve within a few months with "zero therapy," but distress over the appearance of POD and the unpredictable course of POD prompts most patients to desire additional interventions to reduce the duration of symptoms.

Δ Mild POD involves a relatively small area of facial skin and does not cause the patient significant emotional distress. Moderate to severe POD may be considered POD with numerous papules, large areas of confluent involvement, or bothersome symptoms or POD that induces significant emotional distress.

◊ Pimecrolimus is our preferred therapy because it has the most efficacy data. However, erythromycin and metronidazole are reasonable, less expensive options for therapy.

§ Long courses of treatment with tetracyclines are not recommended for children under the age of eight because of adverse effects on permanent teeth and bone in this population.

¥ Following discontinuation of successful treatment, we typically advise patients to engage in gentle skin care practices (use of gentle cleansers and bland emollients). Cosmetic products may be slowly reintroduced (eg, one product per week). Refer to UpToDate topics on perioral (periorificial) dermatitis for additional details.

‡ Gastrointestinal distress is a side effect that may limit use of erythromycin in some patients. Azithromycin is an alternative; however, efficacy data are limited.

† Limited data suggest that various other topical, systemic, and procedural therapies may be beneficial for POD. Further study is necessary to confirm efficacy of these treatments. Refer to UpToDate topics on perioral (periorificial) dermatitis for information on alternative treatments.