Critical Appraisal of Reports on the Treatment of Perioral Dermatitis

Abstract

Background: Presently, problems exist with the rationale of oral therapy and the nature and indication of topical and accompanying treatment of perioral dermatitis. Objective: Providing the basis to overcome these problems by a quality evaluation of treatment reports and assessment of the consistency of treatment experience. Methods: Sources were Medline (1964–2004), Embase (1966–2004), the Cochrane Central (1971–2004) and 526 ref erences of 3 textbooks, 2 recent reviews and 30 papers on perioral dermatitis. Thirty English and German articles were selected. These studies were evaluated according to principles of evidence-based medicine and related criteria. Evaluation of 28 papers was carried out by the authors and of our own 2 papers by 2 other reviewers. Consistency of results was qualitatively assessed by the authors. Results: There wereonly 2 therapeutic trials of medium-range quality. The other studies were of low quality. Consistency was noted concerning treatment with oral tetracycline (with 1 exception), discontinuation of topical corticosteroids and cosmetics and, to a lesser extent, regarding no therapy. There was inconsistency in respect to topical therapy. Conclusion: The presented data help to interpret and conduct studies on the treatment of perioral dermatitis.

Antibiotics used in nonbacterial dermatologic conditions

“…Duration of therapy is 3-4 months (28), and may include a taper over the last 2-4 weeks (30). After reviewing the quality of the studies on treatment of perioral dermatitis, Weber et al found that there is most support for use of oral tetracycline (31). Tetracyclines should not be used in children under 8 and nursing mothers; oral erythromycin is recommended (30).…”

Perioral dermatitis

“…An exact history commonly gives key differential diagnotic clues. The other above‐mentioned diagnoses only rarely come into question and must mainly be considered in cases of lupoid perioral dermatitis [19].…”

“…This is a fundamental problem in the evaluation of different therapeutic approaches according to the criteria of evidence‐based medicine. Thus, in a systematic review from 2005 the inconsistent results in studies with topical treatment approaches for POD were emphasized [19]. Only two papers published before 2005 were rated by the authors with a medium score with respect to methodical quality of controlled studies [23, 24].…”

“…Understandably, no prospective, controlled studies on zero therapy exist. Weber and Thurmayr published a systematic review of therapy of POD in 2005 [19] and point to two studies that support the efficacy of zero therapy:…”

Scoring of Skin Lesions with the Perioral Dermatitis Severity Index (PODSI)

“…Topical metronidazole or oral tetracyclines have been recommended, but there is no evidence from controlled clinical trials to support this (5). Furthermore, there is no such instrument for grading of POD severity, as there is for atopic dermatitis (6) or psoriasis (7).…”