Dermatology - Perioral Dermatitis

Dermatology - Perioral Dermatitis
Perioral dermatitis primarily affects females and typically starts between the ages of 16 and 45, however it can also occur in infants and the elderly. The exact etiology is uncertain, although outbreaks are significantly worsened by the use of strong topical (fluorinated) glucocorticoids.

The lesions persist for a duration of weeks to months and are frequently seen as a form of cosmetic deformity. Intermittent stinging, burning, or sensation of constriction may occur.
Abnormalities
The individual has small, raised, red bumps with pus-filled centers, about 1 to 2 millimeters in diameter. These bumps are located on a red backdrop and are arranged in an irregular and symmetrical pattern. The number of plaques increases when they merge together at a central point and form satellites. Confluent plaques may have an eczematous appearance with small scales. No comedones are present. There is a possibility of a narrow region of unaffected skin around the red border of the lips, and sores may also develop in the areas surrounding the nose and eyes.

The diagnosis is made based on clinical examination, and the possible conditions to consider are allergic contact dermatitis, atopic dermatitis, seborrheic dermatitis, rosacea, acne vulgaris, and steroid acne.

Apply Topical Metronidazole, 0.75% gel twice daily or 1% gel once daily. Apply erythromycin, 2% gel twice daily. Do not use glucocorticoids.
Administer systemic Minocycline or doxycycline at a dosage of 100 mg per day until the condition is resolved, followed by a dosage of 50 mg per day for an additional 2 months. Please note that doxycycline is a medicine that increases sensitivity to sunlight. The recommended dosage for Tetracycline is 500 mg taken twice daily until the symptoms clear up. After that, the dosage should be reduced to 500 mg taken once daily for a duration of 1 month. Following this, the dosage should be further reduced to 250 mg taken once daily for an extra month.