Perioral Dermatitis Treatment | Dermatology Education Perioral Dermatitis Treatment Video
December 14, 2018

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Perioral Dermatitis Treatment

Perioral dermatitis treatment

Patients are advised to simplify their topical regimens. Avoid the routine use of moisturizers unless they absolutely necessary. Cosmetics should be water based or avoided. Benzoyl peroxide is not well tolerated in this sensitive area. It may cause drying and scaling.

Topical steroids may be the cause and these must be stopped. Patients who have used Group V or stronger topical steroids may have to endure a 3 to 6 week recovery period. Erythema and pustules that occur soon after stopping the steroid are treated with cool wet compress. The same oral antibiotics used to treat acne such as doxycycline may be helpful during this recovery period.

Mild to moderate cases of perioral dermatitis may be treated with topical antibiotics. These medications are not predictably effective. Patients may not feel that oral antibiotics are warranted for such a localized minor condition, others are anxious to clear the eruption rapidly and elect to use the more effective oral antibiotics.

Use metronidazole cream (MetroCream, Noritate), sodium sulfacetamide 10% (Klaron), clindamycin lotion or erythromycin solution. Pimecrolimus cream 1% (Elidel), and tacrolimus 0.03%, 0.1% ointment (Protopic) may by helpful.

Metronidazole cream

Sulfacetamide

Clindamycin lotion

Erythromycin solution

Pimecrolimus cream

Tacrolimus ointment

Oral antibiotics are used if a 4 to 6 week course of topical treatment fails.

Tetracycline (500 mg twice a day), erythromycin (500 mg twice a day), doxycycline (100 mg twice a day), or minocycline (100 mg twice a day) is given for a 2 to 4 week course. The condition of many patients responds to lower doses.

Tetracycline

Erythromycin

Doxycycline

Minocycline

Once the condition is resolved, the antibiotic is stopped or tapered over 4 to 5 week period. Some patients clear and remain in remission. Other require long term suppression or intermittent course or oral antibiotics for control.