Skip to main content
Log in

Perioral Dermatitis: A Review of the Condition with Special Attention to Treatment Options

  • Review Article
  • Published:
American Journal of Clinical Dermatology Aims and scope Submit manuscript

Abstract

Perioral dermatitis is a common acneiform facial eruption found in both adults and children. Its variants are periorificial and granulomatous periorificial dermatitis. The etiology of perioral dermatitis remains unknown; however, topical corticosteroid use on the face commonly precedes the manifestation of this condition. There are an overwhelming number of treatment options for perioral dermatitis, and the options in children are slightly different from those in adults for both systemic medications and topical treatment. This article provides a literature review of the various applicable treatments available based on the level and quality of the evidence by the US Preventive Service Task Force. Oral tetracycline reveals the best valid evidence. However, if the patient is less than 8 years old, then this oral therapy may not be suitable. Topical metronidazole, erythromycin, and pimecrolimus also represent effective treatment choices with good evidence. Topical corticosteroid use is common in these cases and the question of whether it is a good treatment or a cause remains unanswered. Corticosteroid cream can improve the clinical picture, but there is a risk of rebound when treatment is stopped. We propose a treatment algorithm to assist dermatologists, pediatric dermatologists, and general practitioners encountering this condition.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Nguyen V, Eichenfield LF. Periorificial dermatitis in children and adolescents. J Am Acad Dermatol. 2006;55(5):781–5.

    Article  PubMed  Google Scholar 

  2. Hafeez ZH. Perioral dermatitis: an update. Int J Dermatol. 2003;42(7):514–7.

    Article  PubMed  Google Scholar 

  3. Laude TA, Salvemini JN. Perioral dermatitis in children. Semin Cutan Med Surg. 1999;18(3):206–9.

    Article  PubMed  CAS  Google Scholar 

  4. Lipozencic J, Ljubojevic S. Perioral dermatitis. Clin Dermatol. 2011;29(2):157–61.

    Article  PubMed  Google Scholar 

  5. Hengge UR, Ruzicka T, Schwartz RA, Cork MJ. Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol. 2006;54(1):1–15 quiz 6-8.

    Article  PubMed  Google Scholar 

  6. Bradford LG, Montes LF. Perioral dermatitis and Candida albicans. Arch Dermatol. 1972;105(6):892–5.

    Article  PubMed  CAS  Google Scholar 

  7. Takiwaki H, Tsuda H, Arase S, Takeichi H. Differences between intrafollicular microorganism profiles in perioral and seborrhoeic dermatitis. Clin Exp Dermatol. 2003;28(5):531–4.

    Article  PubMed  CAS  Google Scholar 

  8. Hsu CK, Hsu MM, Lee JY. Demodicosis: a clinicopathological study. J Am Acad Dermatol. 2009;60(3):453–62.

    Article  PubMed  Google Scholar 

  9. Berardi P, Benvenuti S, Genga A, Cecchini F. Demonstration of fusobacteria in eruptions of perioral dermatitis using the tape stripping toluidine blue (TSTB) method. J Eur Acad Dermatol Venereol. 1994;3:495–9.

    Article  Google Scholar 

  10. Wells K, Brodell RT. Topical corticosteroid ‘addiction’. A cause of perioral dermatitis. Postgrad Med. 1993;93(5):225–30.

    PubMed  CAS  Google Scholar 

  11. Shiri J, Amichai B. Perioral dermatitis induced by inhaled corticosteroids. J Dermatol Treat. 1998;9:259–60.

    Article  Google Scholar 

  12. Dubus JC, Marguet C, Deschildre A, Mely L, Le Roux P, Brouard J, et al. Local side-effects of inhaled corticosteroids in asthmatic children: influence of drug, dose, age, and device. Allergy. 2001;56(10):944–8.

    Article  PubMed  CAS  Google Scholar 

  13. Kumar P, Parashette KR, Noronha P. Letter: Perioral dermatitis in a child associated with an inhalation steroid. Dermatol Online J. 2010;16(4):13.

    PubMed  Google Scholar 

  14. Clementson B, Smidt AC. Periorificial dermatitis due to systemic corticosteroids in children: report of two cases. Pediatr Dermatol. 2012;29(3):331–2.

    Article  PubMed  Google Scholar 

  15. Mellette JR, Aeling JL, Nuss DD. Letter: Fluoride tooth paste: a cause of perioral dermatitis. Arch Dermatol. 1976;112(5):730–1.

    Article  PubMed  CAS  Google Scholar 

  16. Ferlito TA. Tartar-control toothpaste and perioral dermatitis. J Clin Orthod. 1992;26(1):43–4.

    PubMed  CAS  Google Scholar 

  17. Abele DC. ‘Moisturizers’ and perioral dermatitis. Arch Dermatol. 1977;113(1):110.

    Article  PubMed  CAS  Google Scholar 

  18. Malik R, Quirk CJ. Topical applications and perioral dermatitis. Australas J Dermatol. 2000;41(1):34–8.

    Article  PubMed  CAS  Google Scholar 

  19. Abeck D, Geisenfelder B, Brandt O. Physical sunscreens with high sun protection factor may cause perioral dermatitis in children. J Dtsch Dermatol Ges. 2009;7(8):701–3.

    PubMed  Google Scholar 

  20. Guarneri F, Marini H. An unusual case of perioral dermatitis: possible pathogenic role of neurogenic inflammation. J Eur Acad Dermatol Venereol. 2007;21(3):410–2.

    Article  PubMed  CAS  Google Scholar 

  21. Rallis G, Papakosta V, Petrakogiannis C, Zachariades N. Perioral dermatitis following orthognathic surgery. Plast Reconstr Surg. 2004;113(2):771–3.

    Article  PubMed  Google Scholar 

  22. Satyawan I, Oranje AP, van Joost T. Perioral dermatitis in a child due to rosin in chewing gum. Contact Dermat. 1990;22(3):182–3.

    Article  CAS  Google Scholar 

  23. Jansen T. Perioral dermatitis successfully treated with topical adapalene. J Eur Acad Dermatol Venereol. 2002;16(2):175–7.

    Article  PubMed  CAS  Google Scholar 

  24. Dirschka T, Szliska C, Jackowski J, Tronnier H. Impaired skin barrier and atopic diathesis in perioral dermatitis. J Dtsch Dermatol Ges. 2003;1(3):199–203.

    Article  PubMed  Google Scholar 

  25. Adams SJ, Davison AM, Cunliffe WJ, Giles GR. Perioral dermatitis in renal transplant recipients maintained on corticosteroids and immunosuppressive therapy. Br J Dermatol. 1982;106(5):589–92.

    Article  PubMed  CAS  Google Scholar 

  26. Hogan DJ. Perioral dermatitis. Curr Probl Dermatol. 1995;22:98–104.

    PubMed  CAS  Google Scholar 

  27. Rodriguez-Martin M, Saez-Rodriguez M, Carnerero-Rodriguez A, Rodriguez-Garcia F, Cabrera de Paz R, Sidro-Sarto M, et al. Treatment of perioral dermatitis with topical pimecrolimus. J Am Acad Dermatol. 2007;56(3):529–30.

    Article  PubMed  Google Scholar 

  28. Goss JM, Nord KM, Olarte MR, Grossman ME. Perioral dermatitis in a patient with myasthenia gravis following systemic corticosteroid treatment. Br J Dermatol. 2007;156(3):582.

    Article  PubMed  CAS  Google Scholar 

  29. Kuflik JH, Janniger CK, Piela Z. Perioral dermatitis: an acneiform eruption. Cutis. 2001;67(1):21–2.

    PubMed  CAS  Google Scholar 

  30. Urbatsch AJ, Frieden I, Williams ML, Elewski BE, Mancini AJ, Paller AS. Extrafacial and generalized granulomatous periorificial dermatitis. Arch Dermatol. 2002;138(10):1354–8.

    Article  PubMed  Google Scholar 

  31. Hansen KK, McTigue MK, Esterly NB. Multiple facial, neck, and upper trunk papules in a black child. Childhood granulomatous perioral dermatitis with involvement of the neck and upper trunk. Arch Dermatol. 1992;128(10):1396–7, 9.

    Google Scholar 

  32. Frieden IJ, Prose NS, Fletcher V, Turner ML. Granulomatous perioral dermatitis in children. Arch Dermatol. 1989;125(3):369–73.

    Article  PubMed  CAS  Google Scholar 

  33. Marks R, Black MM. Perioral dermatitis. A histopathologic study of 26 cases. Br J Dermatol. 1971;84(3):242–7.

    Article  PubMed  CAS  Google Scholar 

  34. Misago N, Nakafusa J, Narisawa Y. Childhood granulomatous periorificial dermatitis: lupus miliaris disseminatus faciei in children? J Eur Acad Dermatol Venereol. 2005;19(4):470–3.

    Article  PubMed  CAS  Google Scholar 

  35. van de Scheur MR, van der Waal RI, Starink TM. Lupus miliaris disseminatus faciei: a distinctive rosacea-like syndrome and not a granulomatous form of rosacea. Dermatology. 2003;206(2):120–3.

    Article  PubMed  Google Scholar 

  36. Moloney FJ, Egan CA. Case 3. Acne agminata (lupus miliaris disseminatus faciei). Clin Exp Dermatol. 2003;28(6):685–6.

    Article  PubMed  CAS  Google Scholar 

  37. Crawford GH, Pelle MT, James WD. Rosacea: I. Etiology, pathogenesis, and subtype classification. J Am Acad Dermatol. 2004;51(3):327–41 quiz 42-4.

    Article  PubMed  Google Scholar 

  38. Drolet B, Paller AS. Childhood rosacea. Pediatr Dermatol. 1992;9(1):22–6.

    Article  PubMed  CAS  Google Scholar 

  39. Smith KW. Perioral dermatitis with histopathologic features of granulomatous rosacea: successful treatment with isotretinoin. Cutis. 1990;46(5):413–5.

    PubMed  CAS  Google Scholar 

  40. Khokhar O, Khachemoune A. A case of granulomatous rosacea: sorting granulomatous rosacea from other granulomatous diseases that affect the face. Dermatol Online J. 2004;10(1):6.

    PubMed  Google Scholar 

  41. Kroshinsky D, Glick SA. Pediatric rosacea. Dermatol Ther. 2006;19(4):196–201.

    Article  PubMed  Google Scholar 

  42. Tarm K, Creel NB, Krivda SJ, Turiansky GW. Granulomatous periorificial dermatitis. Cutis. 2004;73(6):399–402.

    PubMed  Google Scholar 

  43. Williams HC, Ashworth J, Pembroke AC, Breathnach SM. FACE—facial Afro-Caribbean childhood eruption. Clin Exp Dermatol. 1990;15(3):163–6.

    Article  PubMed  CAS  Google Scholar 

  44. Knautz MA, Lesher JL Jr. Childhood granulomatous periorificial dermatitis. Pediatr Dermatol. 1996;13(2):131–4.

    Article  PubMed  CAS  Google Scholar 

  45. Nedorost ST. Medical Pearl: the evaluation of perioral dermatitis: use of an extended patch test series. J Am Acad Dermatol. 2007;56(5 Suppl):S100–2.

    Article  PubMed  Google Scholar 

  46. Wilkinson DS, Kirton V, Wilkinson JD. Perioral dermatitis: a 12-year review. Br J Dermatol. 1979;101(3):245–57.

    Article  PubMed  CAS  Google Scholar 

  47. Dirschka T, Weber K, Tronnier H. Topical cosmetics and perioral dermatitis. J Dtsch Dermatol Ges. 2004;2(3):194–9.

    Article  PubMed  Google Scholar 

  48. Frumess GM, Lewis HM. Light-sensitive seborrheid. AMA Arch Derm. 1957;75(2):245–8.

    Article  PubMed  CAS  Google Scholar 

  49. Miller WS. Tetracycline in the treatment of perioral dermatitis. N C Med J. 1971;32(11):471–2.

    PubMed  CAS  Google Scholar 

  50. Macdonald A, Feiwel M. Perioral dermatitis: aetiology and treatment with tetracycline. Br J Dermatol. 1972;87(4):315–9.

    Article  PubMed  CAS  Google Scholar 

  51. Sneddon I. Perioral dermatitis. Br J Dermatol. 1972;87(5):430–4.

    Article  PubMed  CAS  Google Scholar 

  52. Sneddon I. A trial of hydrocortisone butyrate in the treatment of rosacea and perioral dermatitis. Br J Dermatol. 1973;89(5):505–8.

    Article  PubMed  CAS  Google Scholar 

  53. Bendl BJ. Perioral dermatitis: etiology and treatment. Cutis. 1976;17(5):903–8.

    PubMed  CAS  Google Scholar 

  54. Urabe H, Koda H. Perioral dermatitis and rosacea-like dermatitis: clinical features and treatment. Dermatologica. 1976;152(Suppl 1):155–60.

    Article  PubMed  Google Scholar 

  55. Cochran RE, Thomson J. Perioral dermatitis: a reappraisal. Clin Exp Dermatol. 1979;4(1):75–80.

    Article  PubMed  CAS  Google Scholar 

  56. Cotterill JA. Perioral dermatitis. Br J Dermatol. 1979;101(3):259–62.

    Article  PubMed  CAS  Google Scholar 

  57. Wilson RG. Topical tetracycline in the treatment of perioral dermatitis. Arch Dermatol. 1979;115(5):637.

    Article  PubMed  CAS  Google Scholar 

  58. Bikowski JB. Topical therapy for perioral dermatitis. Cutis. 1983;31(6):678–82.

    PubMed  CAS  Google Scholar 

  59. Coskey RJ. Perioral dermatitis. Cutis. 1984;34(1):55–6, 8.

    Google Scholar 

  60. Veien NK, Munkvad JM, Nielsen AO, Niordson AM, Stahl D, Thormann J. Topical metronidazole in the treatment of perioral dermatitis. J Am Acad Dermatol. 1991;24(2 Pt 1):258–60.

    Article  PubMed  CAS  Google Scholar 

  61. Manders SM, Lucky AW. Perioral dermatitis in childhood. J Am Acad Dermatol. 1992;27(5 Pt 1):688–92.

    Article  PubMed  CAS  Google Scholar 

  62. Weber K, Thurmayr R. A topical erythromycin preparation and oral tetracycline for the treatment of perioral dermatitis: a placebo-controlled trial. J Dermatol Treat. 1993;4:57–9.

    Article  Google Scholar 

  63. Boeck K, Abeck D, Werfel S, Ring J. Perioral dermatitis in children—clinical presentation, pathogenesis-related factors and response to topical metronidazole. Dermatology. 1997;195(3):235–8.

    Article  PubMed  CAS  Google Scholar 

  64. Weber K. How I treat perioral dermatitis: non-compliance with the treatment guidelines. Dermatology. 2003;207(2):215.

    Article  PubMed  Google Scholar 

  65. Jansen T. Azelaic acid as a new treatment for perioral dermatitis: results from an open study. Br J Dermatol. 2004;151(4):933–4.

    Article  PubMed  CAS  Google Scholar 

  66. Richey DF, Hopson B. Photodynamic therapy for perioral dermatitis. J Drugs Dermatol. 2006;5(2 Suppl):12–6.

    PubMed  Google Scholar 

  67. Oppel T, Pavicic T, Kamann S, Brautigam M, Wollenberg A. Pimecrolimus cream (1%) efficacy in perioral dermatitis—results of a randomized, double-blind, vehicle-controlled study in 40 patients. J Eur Acad Dermatol Venereol. 2007;21(9):1175–80.

    PubMed  CAS  Google Scholar 

  68. Schwarz T, Kreiselmaier I, Bieber T, Thaci D, Simon JC, Meurer M, et al. A randomized, double-blind, vehicle-controlled study of 1% pimecrolimus cream in adult patients with perioral dermatitis. J Am Acad Dermatol. 2008;59(1):34–40.

    Article  PubMed  Google Scholar 

  69. Kihiczak GG, Cruz MA, Schwartz RA. Periorificial dermatitis in children: an update and description of a child with striking features. Int J Dermatol. 2009;48(3):304–6.

    Article  PubMed  Google Scholar 

  70. Jansen T, Melnik BC, Schadendorf D. Steroid-induced periorificial dermatitis in children—clinical features and response to azelaic acid. Pediatr Dermatol. 2010;27(2):137–42.

    Article  PubMed  Google Scholar 

  71. Ishiguro N, Maeda A, Suzuki K, Yamana Y, Fukuya Y, Kawashima M. Three cases of perioral dermatitis related to fusobacteria treated with beta-lactam antibiotics. J Dermatolog Treat. 2014;25(6):507–9.

    Article  PubMed  Google Scholar 

  72. Miller SR, Shalita AR. Topical metronidazole gel (0.75%) for the treatment of perioral dermatitis in children. J Am Acad Dermatol. 1994;31(5 Pt 2):847–8.

    Article  PubMed  CAS  Google Scholar 

  73. Zalaudek I, Di Stefani A, Ferrara G, Argenziano G. Childhood granulomatous periorificial dermatitis: a controversial disease. J Dtsch Dermatol Ges. 2005;3(4):252–5.

    Article  PubMed  Google Scholar 

  74. Choi YL, Lee KJ, Cho HJ, Kim WS, Lee JH, Yang JM, et al. Case of childhood granulomatous periorificial dermatitis in a Korean boy treated by oral erythromycin. J Dermatol. 2006;33(11):806–8.

    Article  PubMed  Google Scholar 

  75. Hussain W, Daly BM. Granulomatous periorificial dermatitis in an 11-year-old boy: dramatic response to tacrolimus. J Eur Acad Dermatol Venereol. 2007;21(1):137–9.

    Article  PubMed  CAS  Google Scholar 

  76. Ahmed I. Clinicopathologic challenge. Childhood granulomatous peri-orificial dermatitis with extra-facial lesions. Int J Dermatol. 2007;46(2):143–5.

    Article  PubMed  Google Scholar 

  77. Rodriguez-Caruncho C, Bielsa I, Fernandez-Figueras MT, Ferrandiz C. Childhood granulomatous periorificial dermatitis with a good response to oral metronidazole. Pediatr Dermatol. 2013;30(5):e98–9.

    Article  PubMed  Google Scholar 

  78. Ellis CN, Stawiski MA. The treatment of perioral dermatitis, acne rosacea, and seborrheic dermatitis. Med Clin North Am. 1982;66(4):819–30.

    PubMed  CAS  Google Scholar 

  79. Bikowski JB. Treatment of rosacea with doxycycline monohydrate. Cutis. 2000;66(2):149–52.

    PubMed  CAS  Google Scholar 

  80. Bornhovd EC, Burgdorf WH, Wollenberg A. Immunomodulatory macrolactams for topical treatment of inflammatory skin diseases. Curr Opin Investig Drugs. 2002;3(5):708–12.

    PubMed  CAS  Google Scholar 

  81. Schuller E, Oppel T, Bornhovd E, Wetzel S, Wollenberg A. Tacrolimus ointment causes inflammatory dendritic epidermal cell depletion but no Langerhans cell apoptosis in patients with atopic dermatitis. J Allergy Clin Immunol. 2004;114(1):137–43.

    Article  PubMed  CAS  Google Scholar 

  82. Hoetzenecker W, Ecker R, Kopp T, Stuetz A, Stingl G, Elbe-Burger A. Pimecrolimus leads to an apoptosis-induced depletion of T cells but not Langerhans cells in patients with atopic dermatitis. J Allergy Clin Immunol. 2005;115(6):1276–83.

    Article  PubMed  CAS  Google Scholar 

  83. Akamatsu H, Komura J, Asada Y, Miyachi Y, Niwa Y. Inhibitory effect of azelaic acid on neutrophil functions: a possible cause for its efficacy in treating pathogenetically unrelated diseases. Arch Dermatol Res. 1991;283(3):162–6.

    Article  PubMed  CAS  Google Scholar 

  84. Tarimci N, Sener S, Kilinc T. Topical sodium sulfacetamide/sulfur lotion. J Clin Pharm Ther. 1997;22(4):301.

    Article  PubMed  CAS  Google Scholar 

  85. Sauder D, Miller R, Gratton D. The treatment of rosacea: the safety and efficacy of sodium sulfacetamide 10% and sulfur 5% lotion is demonstrated in a double blind study. J Dermatolog Treat. 1997;8:79–85.

    Article  Google Scholar 

  86. Nally JB, Berson DS. Topical therapies for rosacea. J Drugs Dermatol. 2006;5(1):23–6.

    PubMed  Google Scholar 

  87. Olansky S. Old drug—in a new system—revisited. Cutis. 1977;19(6):852–4.

    PubMed  CAS  Google Scholar 

  88. Mackley CL, Thiboutot DM. Diagnosing and managing the patient with rosacea. Cutis. 2005;75(4 Suppl):25–9.

    PubMed  Google Scholar 

Download references

Statement of Funding

None.

Conflict of Interest Disclosures

Dr. Tor A. Shwayder: None.

Dr. Therdpong Tempark: None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Therdpong Tempark.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tempark, T., Shwayder, T.A. Perioral Dermatitis: A Review of the Condition with Special Attention to Treatment Options. Am J Clin Dermatol 15, 101–113 (2014). https://doi.org/10.1007/s40257-014-0067-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40257-014-0067-7

Keywords

Navigation