Perioral Dermatitis in Children – Clinical Presentation, Pathogenesis-Related Factors and Response to Topical Metronidazole

Abstract

Background: Perioral dermatitis, a common skin disorder in young women, is rarely described in children. Objective: This study elaborates the clinical features of perioral dermatitis in children as well as possible pathogenetic mechanisms and the response to topical metronidazole. Methods: Seven children (4 females, 3 males between 4 and 12 years of age) were evaluated and dermatological examination was carried out. Pretreatment with topical corticosteroids was documented. Skin prick test with a panel of six common aeroallergens was performed in all children. All children were screened for gastrointestinal colonization with Candida albicans. Patients were treated with topical metronidazole 1% during the first 2 weeks. From the 3rd week on 2% metronidazole was used. Results: In all but one child topical corticosteroids had been used in the face prior to the first presentation at our outpatient department suggesting a possible pathogenetic role. An association with atopy or intestinal Candida colonization was not found. In all children skin lesions resolved after 3–6 months. The children remained free of symptoms over an observation period of 2 years. Conclusion: Perioral dermatitis has to be considered as differential diagnosis in children presenting with erythematous papules and papulovesicles in typical locations. Metronidazole proved to be effective and safe in the treatment of perioral dermatitis in children. Atopy and gastrointestinal colonization with C. albicans do not seem to play a role in the pathogenesis of perioral dermatitis.

Critical Appraisal of Reports on the Treatment of Perioral Dermatitis

“…We found 30 studies [4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33] to contain at least partly appropriate information about the treatment of POD (table 3). The quality evaluation based on principles of evidence-based medicine [36] only revealed 2 studies with a medium-range score of 4 [5, 6] and the remaining 28 studies with scores between 0.5 and 2.5 (tables 1, 3) which we regarded to be of low quality.…”

“…According to the other randomised studies, 9% [5] and 18% [6] of the patients did not return for follow-up. The other papers received 1 point [12, 13, 18, 22,24,25,26, 29], 0.5 point [7,8,9,10,14,15,16,17,19,20,21, 23, 28, 30, 32, 33] or a score of 0 [11, 27, 31]. …”

“…Up to February 2004, sources for this study were Medline (1964–2004), Embase (1966–2004), the Central Register of Controlled Clinical Trials (Central) of the Cochrane Library (1971–2004) and the 526 references of 3 textbook articles [1,2,3], the 30 papers cited in this study [4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33] and 2 recent reviews [34, 35]. In Medline and Embase, 125 out of 215 and 296 out of 454 articles, respectively, were found referring to ‘perioral (and) dermatitis and therapy’.…”

“…Search was for studies containing any information on the therapy of POD based on at least 9 patients, but smaller case series were also selected if they had been mentioned frequently in the literature [11, 19, 25] or in the Cochrane Central [28]. In the Cochrane Central, only 6 out of 8 articles referred to treatment of POD [[5, 6, 11, 12, 27, 28].…”

“…A reasonable statistical analysis was not possible because of lack of pertinent data and the low level of evidence found in most papers [4,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33] and since the 2 papers with medium-range quality [5, 6] were different in several respects. …”