Acta clinica Croatica, Vol. 54. No. 2., 2015.
Case report
Perioral Dermatitis: Still a Therapeutic Challenge
Zrinka Bukvic Mokos
; University Department of Dermatology and Venereology, Zagreb University Hospital Center, School of Medicine, University of Zagreb, Zagreb, Croatia
Ana Kummer
; Blaženka Tomić-Kummer Pediatric Office, Zaprešić, Croatia
Elvira Lazić Mosler
; Dr. Ivo Pedišić General Hospital, Sisak, Croatia
Romana Čeović
; University Department of Dermatology and Venereology, Zagreb University Hospital Center, School of Medicine, University of Zagreb, Zagreb, Croatia
Aleksandra Basta-Juzbašić
; University Department of Dermatology and Venereology, Zagreb University Hospital Center, School of Medicine, University of Zagreb, Zagreb, Croatia
Abstract
Perioral dermatitis is a common and often chronic dermatosis. In its classic form, it primarily affects women aged 15 to 45 years, but there are also variants including lupus-like and granulomatous perioral dermatitis, where granulomatous form is more common in childhood and affects mostly prepubescent boys. The etiopathogenesis of the disease remains unclear, but there is a frequent finding of prolonged use of topical products, especially corticosteroids, in the treatment of rosacea and seborrheic dermatitis, preceding the clinical manifestation of perioral dermatitis. Other causes important for the occurrence of the disease include various skin irritants, as well as other physical and hormonal factors, which all share the epidermal barrier dysfunction as an underlying main pathogenic factor. Clinical presentation of papulovesicular eruption in the perioral region with a typical narrow spared zone around the edge of the lips is characteristic. Therapeutic approach should be individually addressed, depending on the severity of clinical presentation and patient’s age, with special attention to patient’s education and continuous psychological support. In mild forms of perioral dermatitis, ‘zero therapy’ is the treatment of choice. In the initial treatment period, patients with steroid-induced perioral dermatitis should be closely followed up because the rebound phenomenon usually develops after cessation of previous topical treatment. In moderate disease, treatment includes topical metronidazole, erythromycin, and pimecrolimus, whereas in more severe cases the best validated choice is oral tetracycline in a subantimicrobial dose until complete remission is achieved. Systemic isotretinoin should be considered as a therapeutic option for patients refractory to all standard therapies.
Keywords
Dermatitis, perioral – etiology; Dermatitis, perioral – therapy; Individualized medicine
Hrčak ID:
145464
URI
Publication date:
1.7.2015.
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