January 2015 | Case of the month - gain CPD points

1. Diagnosis

• The diagnosis is perioral dermatitis, which is an erythematous eruption of small papules and papulopustules with a distribution primarily around the mouth. It can also affect the skin around the eyes (periocular dermatitis). It is a poorly named condition as it is not a dermatitis
• Although the exact cause of perioral dermatitis is not understood, the use of topical steroid therapy either directly or indirectly (eg the area has been touched by fingers that are treating another part of the body with steroid creams) is, for many, an important aetiological factor
   

2. Management

• Discontinue any topical steroids being used on the face, or other facial creams that may be causing the symptoms. Warn patients that after withdrawal of the steroid cream the symptoms are likely to get worse for a few days before starting to improve. This flare can be avoided by advising the patient to reduce the frequency of topical steroid application over 1-2 weeks before stopping
• Patients require treatment with:
  • Milder cases - a topical antibiotic eg clindamycin, erythromycin or metronidazole
  • Other patients - a systemic antibiotic for 4-6 weeks eg a tetracycline (oxytetracycline 500 mg BD an hour before food, lymecycline 408 mg OD an hour before food) or erythromycin 500 mg BD

Please refer to the chapter on perioral dermatitis for more information.