Childhood Perioral Dermatitis — Challenging Treatment

Abstract

Background: Also known as papulopustular dermatitis (chronic form), rosacea-like dermatitis, periorificial dermatitis, or airhostess’ dermatitis, perioral dermatitis is a commonly encountered dermatological disease, especially in adult women and less frequently in children. Its diagnosis and treatment are a challenge especially in small children. Case report: We present the case of a 2-year-old girl referred to the dermatologist for widespread erythematous papules, vesicles, and pustules on the perioral area, nasolabial folds, and on the outer region of the lower eyelids. Several diagnoses had been established during the previous months: impetigo, atopic dermatitis, seborrheic dermatitis, allergic contact dermatitis, childhood rosacea, demodecidosis, infantile acne, and variable therapeutic approaches had been tried, with no clinical improvement. Clarithromycin 250 mg/day orally associated with the application of 2% erythromycin solution were successfully used. Conclusion: This case highlights the importance of the clinical diagnosis of perioral dermatitis in young children, of excluding other diagnoses and worthless treatments, and also the chronic evolution of the disease and its individualized treatment.

Perioral dermatitis: Diagnosis, proposed etiologies, and management

“…Doxycycline in doses of 40–100 mg has been used with marked responses and no reported side effects 41 . In separate case reports, oral clarithromycin (250 mg/day), 7 azithromycin 320 mg/day for 5 days, 42 and combination of oral erythromycin 800 mg/day and 0.1% tacrolimus 43 or pimecrolimus 1% 44 markedly improved lesion appearances. Intralesional triamcinolone (0.2 ml of 5.0 mg/ml) successfully treated one patient's lesions 45 .…”

“…Acne vulgaris, steroid-exacerbated rosacea, and lupus miliaris disseminatus faciei may present in a similar distribution to POD and should be excluded. 4,7 Rosacea usually has a centrofacial distribution with absence of comedones and in some cases rhinophyma or ocular symptoms; the latter which are unusual in POD. 8 Acne vulgaris presents with comedones, papules, pustules, nodules, and cysts which are not typical of POD.…”

Efficacy of treatments for rosacea in the pediatric population: A systematic review

“…17 Clarithromycin (10 patients: 10 systemically) Eight articles studying 10 patients were identified. 17,[24][25][26][27][28][29][30] Five patients (5/10, 50%) were diagnosed with AFG and treated with clarithromycin orally with the most common doses being 250 mg/day or 15 mg/kg/day. One of these patients were treated with clarithromycin monotherapy, achieving full remission in 1 month.…”

“…All patients achieved partial remission between 1 and 8 months. 25,26,28 Two patients (2/10, 20%) were diagnosed with granulomatous rosacea and both achieved full remission in 3 months after treatment with clarithromycin ± topical metronidazole. 27 Erythromycin (143 patients: 3 topically, 140 systemically) Twenty-four articles studying a total of 143 patients were identified.…”

Manejo de la dermatitis perioral: reporte de un caso

“…También conocida como dermatitis papulopustulosa (forma crónica), dermatitis similar a la rosácea, dermatitis periorificial o dermatitis de azafata 3 .…”