tetracycline and Dermatitis--Perioral

Perioral dermatitis presents as an eruption of erythematous papules, pustules and papulovesicles, most frequently seen in young women. Oral tetracyclines have been considered the first line treatment for years. However, recent publications have found newer agents to be efficacious. The authors performed a review of the available data in order to determine the strength of evidence supporting published therapies. A Pubmed and Cochrane Library database search for all cases, case series, and clinical trials dealing with the treatment of perioral dermatitis in English. Most cases of perioral dermatitis are self-limited, if the possible exacerbants of cosmetics and topical corticosteroids are discontinued ("zero therapy"). Many trials support the use of oral tetracyclines as a first line medication, as it significantly shortens the time to papule resolution. Topical erythromycin also reduces the time to resolution, but not as quickly. Topical pimecrolimus does not appear to decrease the time to complete resolution, but it does rapidly reduce the severity of the disease, particularly if prior corticosteroid use has occurred. The evidence supporting topical metronidazole, which is frequently used to treat perioral dermatitis in children, is relatively weak and supported only by case series and a trial showing it to be inferior to tetracycline. The evidence most strongly supports the efficacy of zero therapy, topical pimecrolimus, oral tetracycline, and topical erythromycin.

Topics: Administration, Topical; Dermatitis, Perioral; Erythromycin; Evidence-Based Medicine; Humans; Metronidazole; Tetracycline

Presently, problems exist with the rationale of oral therapy and the nature and indication of topical and accompanying treatment of perioral dermatitis.. Providing the basis to overcome these problems by a quality evaluation of treatment reports and assessment of the consistency of treatment experience.. Sources were Medline (1964-2004), Embase (1966-2004), the Cochrane Central (1971-2004) and 526 references of 3 textbooks, 2 recent reviews and 30 papers on perioral dermatitis. Thirty English and German articles were selected. These studies were evaluated according to principles of evidence-based medicine and related criteria. Evaluation of 28 papers was carried out by the authors and of our own 2 papers by 2 other reviewers. Consistency of results was qualitatively assessed by the authors.. There were only 2 therapeutic trials of medium-range quality. The other studies were of low quality. Consistency was noted concerning treatment with oral tetracycline (with 1 exception), discontinuation of topical corticosteroids and cosmetics and, to a lesser extent, regarding no therapy. There was inconsistency in respect to topical therapy.. The presented data help to interpret and conduct studies on the treatment of perioral dermatitis.

Topics: Administration, Oral; Administration, Topical; Adult; Dermatitis, Perioral; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Evaluation Studies as Topic; Evidence-Based Medicine; Female; Follow-Up Studies; Humans; Male; Metronidazole; Middle Aged; Randomized Controlled Trials as Topic; Severity of Illness Index; Tetracycline; Treatment Outcome

Granulomatous periorificial dermatitis (GPD) is a distinct facial eruption in prepubertal children that should be distinguished from granulomatous rosacea, perioral dermatitis, and cutaneous sarcoidosis. We describe a case of GPD and review the key distinguishing features of this condition.

Topics: Anti-Bacterial Agents; Child; Dermatitis, Perioral; Diagnosis, Differential; Granuloma; Humans; Male; Steroids; Tetracycline

Topics: Child; Dermatitis, Perioral; Diagnosis, Differential; Facial Dermatoses; Female; Granuloma; Humans; Isotretinoin; Metronidazole; Skin Diseases, Papulosquamous; Tetracycline

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Child; Dermatitis, Perioral; Erythromycin; Female; Humans; Middle Aged; Patient Compliance; Tetracycline