tacrolimus and Dermatitis--Perioral

Childhood granulomatous periorificial dermatitis (CGPD), considered a clinical variant of perioral dermatitis, typically affects prepubertal children of African descent. It is a condition of unknown etiology characterized by the presence of a monomorphic yellow-brown papular eruption limited to the perioral, perinasal, and periocular regions that histopathologically shows a granulomatous pattern. This disorder should be differentiated from other conditions as granulomatous rosacea, sarcoidosis, and lupus miliaris disseminatus faciei. We report a case of a 9-year-old boy who presented with flesh-colored perorificial papules on the face, evolving for two months. Upon treatment with topical tacrolimus for follicular eczema, an aggravation of the condition was observed. A skin biopsy confirmed the diagnosis of CGPD. Our patient was successfully treated with a combination of topical metronidazole and topical erythromycin.

Topics: Administration, Topical; Anti-Infective Agents; Biopsy; Child; Dermatitis, Perioral; Drug Therapy, Combination; Erythromycin; Face; Granuloma; Humans; Immunosuppressive Agents; Male; Metronidazole; Skin; Tacrolimus

Perioral dermatitis (POD) is a common dermatosis without standard therapy.. We sought to evaluate pimecrolimus cream 1% in POD.. We conducted a multicenter, randomized, double-blind, parallel-group study in adult patients with POD treated twice daily with pimecrolimus cream 1% or vehicle until clearance for up to 4 weeks. Follow-up took place 4 and 8 weeks after treatment.. Patients treated with pimecrolimus had an average POD Severity Index score of 2.6 compared with 3.5 for patients treated with vehicle. Both groups had baseline scores of 5.2. The between-group difference was 0.9 (95% confidence level 0.4, 1.4, P = .0011). Patients with history of topical corticosteroids benefited most. Pimecrolimus-treated patients reported greater improvement in quality of life. There were no group differences regarding safety.. Pimecrolimus vehicle is not a true placebo.. Pimecrolimus rapidly improves clinical symptoms and quality of life of patients with POD, being most effective in corticosteroid-induced POD.

Topics: Administration, Cutaneous; Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents, Non-Steroidal; Dermatitis, Perioral; Dermatologic Agents; Double-Blind Method; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Male; Middle Aged; Ointments; Pharmaceutical Vehicles; Quality of Life; Tacrolimus; Treatment Outcome

Perioral dermatitis (POD) is a common skin disease and difficult to treat. Pimecrolimus cream (1%) successfully controls atopic eczema.. Our aim was to investigate its efficacy in POD.. Single-centre, randomized, double-blind, vehicle-controlled study including 40 POD patients with a 4-week treatment and a 4-week follow-up. Efficacy was assessed by a novel Perioral Dermatitis Severity Index (PODSI) and Finlay's Dermatology Life Quality Index (DLQI).. Outpatient clinics of a large dermatological hospital in Munich, Germany.. During treatment, the PODSI was significantly lower in the pimecrolimus group compared with vehicle (P = 0.005-0.02) whereas at follow-up, no significant differences were observed. At week 2, the responder rates (> or = 50% PODSI improvement) were 50% with pimecrolimus cream (1%) and 25% with vehicle (P = 0.095). DLQI was improved in pimecrolimus group compared with vehicle.. Results suggest that pimecrolimus cream (1%) effectively treats acute-stage POD.

Topics: Administration, Topical; Adolescent; Adult; Aged; Dermatitis, Perioral; Dermatologic Agents; Double-Blind Method; Female; Humans; Male; Middle Aged; Quality of Life; Severity of Illness Index; Statistics, Nonparametric; Tacrolimus; Treatment Outcome

Topics: Administration, Topical; Child; Dermatitis, Perioral; Humans; Immunosuppressive Agents; Tacrolimus

Topics: Administration, Cutaneous; Adult; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Deprescriptions; Dermatitis, Perioral; Erythromycin; Glucocorticoids; Humans; Metronidazole; Recurrence; Risk Factors; Tacrolimus; Triamcinolone

Topics: Administration, Topical; Adult; Dermatitis, Perioral; Dermatologic Agents; Humans; Male; Tacrolimus; Time Factors; Treatment Outcome

Childhood granulomatous periorificial dermatitis (CGPD) is a granulomatous disease characterized by monomorphous, small papular eruptions around the mouse, nose and eyes, and is thought to be closely related to perioral dermatitis. This condition has always been believed to occur more commonly in dark-skinned patients; however, recent observations have revealed CGPD to occur also in white patients.. We report an 11-year-old Japanese boy with the characteristic features of CGPD. Although sarcoidosis and acne/granulomatous rosacea could be differentiated from CGPD, we could find no essential differences between CGPD and lupus miliaris disseminatus faciei (LMDF). The cases of LMDF in children, which were recorded in the Japanese literature, had highly similar clinicopathological features to those of CGPD. This case responded dramatically to topical tacrolimus in combination with the oral administration of minocycline.. The entity 'facial idiopathic granulomas with regressive evolution' is considered to include LMDF (a common adult form), CGPD (a rare childhood form) and perioral dermatitis (a peculiar form exacerbated by topical corticosteroids). Topical tacrolimus may be recommended as one of the therapies for LMDF as well as CGPD.

Topics: Administration, Cutaneous; Administration, Oral; Anti-Bacterial Agents; Child; Dermatitis, Perioral; Diagnosis, Differential; Drug Therapy, Combination; Granulomatous Disease, Chronic; Humans; Immunosuppressive Agents; Lupus Vulgaris; Male; Minocycline; Tacrolimus