Perioral Dermatitis: Still a Therapeutic Challenge

Acta Clinica Croatica. 2015;54.(2.):179-184

 

Journal Homepage

Journal Title: Acta Clinica Croatica

ISSN: 0353-9466 (Print); 1333-9451 (Online)

Publisher: Sestre Milosrdnice University hospital, Institute of Clinical Medical Research

LCC Subject Category: Medicine

Country of publisher: Croatia

Language of fulltext: English

Full-text formats available: PDF

 

AUTHORS

Zrinka Bukvic Mokos (University Department of Dermatology and Venereology, Zagreb University Hospital Center, School of Medicine, University of Zagreb, Zagreb, Croatia)
Ana Kummer (Blaženka Tomić-Kummer Pediatric Office, Zaprešić, Croatia)
Elvira Lazić Mosler (Dr. Ivo Pedišić General Hospital, Sisak, Croatia)
Romana Čeović (University Department of Dermatology and Venereology, Zagreb University Hospital Center, School of Medicine, University of Zagreb, Zagreb, Croatia)
Aleksandra Basta-Juzbašić (University Department of Dermatology and Venereology, Zagreb University Hospital Center, School of Medicine, University of Zagreb, Zagreb, Croatia)

EDITORIAL INFORMATION

Peer review

Editorial Board

Instructions for authors

Time From Submission to Publication: 30 weeks

 

Abstract | Full Text

Perioral dermatitis is a common and often chronic dermatosis. In its classic form, it primarily affects women aged 15 to 45 years, but there are also variants including lupus-like and granulomatous perioral dermatitis, where granulomatous form is more common in childhood and affects mostly prepubescent boys. The etiopathogenesis of the disease remains unclear, but there is a frequent finding of prolonged use of topical products, especially corticosteroids, in the treatment of rosacea and seborrheic dermatitis, preceding the clinical manifestation of perioral dermatitis. Other causes important for the occurrence of the disease include various skin irritants, as well as other physical and hormonal factors, which all share the epidermal barrier dysfunction as an underlying main pathogenic factor. Clinical presentation of papulovesicular eruption in the perioral region with a typical narrow spared zone around the edge of the lips is characteristic. Therapeutic approach should be individually addressed, depending on the severity of clinical presentation and patient’s age, with special attention to patient’s education and continuous psychological support. In mild forms of perioral dermatitis, ‘zero therapy’ is the treatment of choice. In the initial treatment period, patients with steroid-induced perioral dermatitis should be closely followed up because the rebound phenomenon usually develops after cessation of previous topical treatment. In moderate disease, treatment includes topical metronidazole, erythromycin, and pimecrolimus, whereas in more severe cases the best validated choice is oral tetracycline in a subantimicrobial dose until complete remission is achieved. Systemic isotretinoin should be considered as a therapeutic option for patients refractory to all standard therapies.