Pharmacological interventions for periorificial (perioral) dermatitis in children and adults: a systematic review

Abstract

The plethora of pharmacologic treatments used for periorificial dermatitis (POD) makes clinical decision‐making challenging. The objectives of this review were to assess the efficacy and safety of pharmacological interventions for POD in children and adults. The search was performed on 2 February 2021 and included seven databases and trial registries, with no date or language restrictions Study selection, data extraction and risk of bias assessments were performed independently and in duplicate by two authors, in accordance with a prespecified protocol. Meta‐analyses were performed and reported in accordance with PRISMA guidelines. Where meta‐analysis was not possible, a narrative synthesis was performed and reported in accordance with SWiM guidelines. The certainty of evidence was assessed using the Grading of Recommendation, Assessment, Development and Evaluation approach. Eleven studies representing 733 participants were included. Oral tetracycline may improve physician‐reported severity of POD from day 20 onwards (low certainty evidence). Adverse effects may include abdominal discomfort, facial dryness and pruritus. Pimecrolimus cream may improve physician‐reported severity slightly after 4 weeks of treatment (MD −0.49, 95% CI −1.02 to 0.04, n = 164, low certainty evidence). Adverse effects may include erythema, herpes simplex virus infection, burning and pruritus. Azelaic acid gel may result in no change in either physician‐ or patient‐reported severity after 6 weeks of treatment. The evidence is very uncertain about the effect of praziquantel ointment on physician‐reported severity and skin‐related quality of life after 4 weeks of treatment. The evidence is also very uncertain about the effect of topical clindamycin/benzoyl peroxide on physician‐reported severity. The body of evidence to inform treatment of POD currently consists of low and very low certainty evidence for important outcomes. Well‐designed trials are needed to further investigate treatment options. Data are required for children and from low‐middle income countries to improve external validity. Future trials should also include adequate post‐treatment follow‐up and standardized outcome measures.

Scientific Rationale and Clinical Basis for Clindamycin Use in the Treatment of Dermatologic Disease

“…Additional dermatologic indications for which clindamycin is a possible treatment option include: pitted keratolysis, cutaneous erythrasma, progressive macular hypomelanosis, and perioral dermatitis [ 72 , 73 , 74 , 75 ]. Clindamycin may be used “off-label” for these and some other indications, provided at least some available clinical findings back the use of clindamycin for such conditions.…”

Treatment of granulomatous perioral dermatitis with 1.5% topical ruxolitinib cream

“… 2 Generally, POD has commonly been reported in young adult females and children but the exact annual incidence is unknown and can vary with geographic location. 3 …”

Pediatric periorificial dermatitis in an Asian population: A comparative study of oral metronidazole and oral macrolides

“…To the Editor: A diverse array of therapeutic agents is available for pediatric periorificial dermatitis (PPD). 1 However, PPD management is mostly supported by nonrandomized studies predominantly involving the Caucasian population, with limited data on the comparison of efficacy between the various oral antibiotics. Therefore, we aimed to address this gap by delineating PPD characteristics in an Asian population and evaluating treatment outcomes of systemic antibiotics, specifically comparing oral metronidazole (OMZ) to oral macrolides.…”