Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Perioral dermatitis


Evidence Levels: A Double-blind study B Clinical trial ≥ 20 subjects C Clinical trial < 20 subjects D Series ≥ 5 subjects E Anecdotal case reports

Perioral dermatitis is a benign, acneiform, facial eruption of children and young female adults. It commonly affects the perioral area with small, inflammatory papules with or without an eczematous dermatitis with a classic zone of sparing the vermilion border and a burning sensation. It may also affect the perinasal and periorbital areas and as such may be referred to as periorificial dermatitis. Although the etiology is unknown, contributing factors include topical, inhaled, and/or systemic corticosteroids. Other suspected triggers include infectious agents ( Demodex , Candida albicans , fusiform bacteria), fluoride and antitartar toothpaste, cosmetics/moisturizers, sunscreens, dental fillings, orthognathic surgery, chewing gum, hormones (premenstrual flares, oral contraceptives, pregnancy), and atopic dermatitis. Granulomatous periorificial dermatitis is a variant more common in prepubescent children characterized by red–brown inflammatory papules without papulopustules or papulovesicles in the typical distribution that may affect extrafacial areas.

Management Strategy

The first step in management of perioral dermatitis is elimination of triggers such as topical, inhaled, or oral corticosteroids in addition to any other irritant triggers such as cosmetics or creams. Patients should be counseled on an expected flare after elimination of corticosteroids; thus, a slow taper of reduction in frequency of the corticosteroids or tapering from high to medium to low corticosteroids with the goal of complete elimination. Gentle cleansers and minimal use of topical, bland products should be recommended.

We recommend pursuing topical treatments prior to systemics, but this may be predicated upon severity of disease, age, and quality of life. Tetracyclines should not be used in children younger than 8 years of age due to discoloration of teeth and bone. Severe and refractory disease, especially the granulomatous variant, may be treated with low-dose isotretinoin .

Specific Investigations

  • No investigation is routinely required

First-Line Therapies

  • Topical pimecrolimus

  • A

  • Oral tetracyclines

  • A

  • Withdrawal of topical corticosteroids

  • B

  • Topical ivermectin

  • B

  • Topical erythromycin

  • B

  • Topical metronidazole

  • B

  • Topical praziquantel

  • B

Periorificial dermatitis in children and adolescents

Nguyen V, Eichenfield LF. J Am Acad Dermatol 2006; 55: 781–5.

A retrospective chart review with telephone follow-up revealed that of 79 children and adolescents, 72% had a history of topical, inhaled, or systemic steroid exposure. Treatment with topical metronidazole showed improvement on follow-up examination.

There was a high incidence of exposure to topical, inhaled, or systemic corticosteroids prior to onset of periorificial dermatitis in this cohort.

A randomized, double-blind, vehicle-controlled study of 1% pimecrolimus cream in adult patients with perioral dermatitis

Schwarz T, Kreiselmaier I, Bieber T, et al. J Am Acad Dermatol 2008; 59: 34–40.

A multicenter, randomized, double-blind, parallel group study of 124 adults using pimecrolimus 1% cream twice daily versus vehicle twice daily for 4 weeks with follow-up at 4 and 8 weeks. Rapid improvement was seen with pimecrolimus within the first 2 weeks, with most benefit in patients with previous use of topical corticosteroids. No significant differences were appreciated at 4 weeks.

New indications for topical ivermectin 1% cream: a case series study

Baranńska-Rybak W, Kowalska-Olędzka E. Adv Dermatol Allergol 2019; 36: 58–62.

A prospective study of 20 cases of inflammatory facial dermatoses, including eight cases of perioral dermatitis (PD), were treated with topical ivermectin 1% oil-in-water base cream once daily for 1–3 months based on clinical response. The PD patients achieved complete or almost complete clearance in 8 weeks.

Topical metronidazole in the treatment of perioral dermatitis

Veien NK, Munkvad JM, Nielsen AO, et al. J Am Acad Dermatol 1991; 24: 258–69.

A prospective, double-blind, multicenter trial of 108 patients were randomized to metronidazole 1% cream compared with oral tetracycline 250 mg twice daily for 8 weeks. Tetracycline was significantly more efficacious than topical metronidazole, but both groups showed improvement.

You're Reading a Preview

Become a Clinical Tree membership for Full access and enjoy Unlimited articles

Become membership

If you are a member. Log in here