Perioral dermatitis in children

Abstract

Perioral dermatitis is a unique skin disorder of childhood. Its exact origin is unknown; it is probably an idiosyncratic response to exogenous factors such as the use of a topical fluorinated corticosteroid or other substances on the face. It is uncommon but not rare. The age of affected children has ranged from 7 months to 13 years, with the median being in the prepubertal period. Boys and girls, blacks and whites are equally affected. Clinical features include the following: (1) absence of systemic symptoms; (2) periorificial distribution (perioral, perinasal, periorbital); (3) skin lesions that consist of flesh colored or erythematous inflammed papules, micronodules, and rare pustules; and (4) variable pruritus. Laboratory tests are negative. Histologically, it is indistinguishable from rosacea; there is a superficial perifollicular granuloma consisting of epitheliod cells, and lymphohistiocytic infiltrate, with occasional giant cells. The disease waxes and wanes for weeks and months. Treatment consists of discontinuing topical fluorinated corticosteroid use if any, and using topical metronidazole alone or in combination with either oral tetracycline or erythromycin depending on the child's age. A low-potency topical steroid may also be used to suppress the inflammation and to wean off the strong steroid. Perioral dermatitis in childhood is probably a juvenile form of rosacea.

Pediatric Periorificial Dermatitis: Clinical Course and Treatment Outcomes in 222 Patients

“…POD was initially termed “light‐sensitive seborrheid” and became known as POD several decades later based on the characteristic papulopustular eruption around the mouth, nose, and eyes . Histologic examination is rarely performed but displays epithelioid cells and lymphohistiocytic infiltrate with occasional giant cells, indistinguishable from rosacea .…”

“…Pediatric periorificial dermatitis (POD) is a common but underreported chronic facial rosacea‐like eruption located around the mouth, nose, and eyes. Since 1957, 90% of POD cases have been described in young adult women . However, pediatric POD has been reported in children as young as 6 months of age, with most cases in children younger than 5 years old .…”

Childhood ocular rosacea: Considerations for diagnosis and treatment

“…3 While topical corticosteroids play a part in adult perioral dermatitis, they usually do not in children, adding support for differentiating between adult and childhood disease. Periorificial dermatitis in adults is in most cases precipitated by the use of topical corticosteroids on the face.…”

“…These studies emphasise the association of recurrent chalazia with rosacea in children. Periorificial dermatitis is not uncommon in children and, while some consider it to be a separate entity to and differential diagnosis for rosacea, 1,2 some studies have found close associations linking periorificial dermatitis to childhood rosacea 3 and, in particular, ocular signs of rosacea. 4 There are no clear guidelines for first-line therapy in childhood rosacea.…”

Application of cutaneous microdialysis to evaluate metronidazole and its main metabolite concentrations in the skin after a single oral dose

“…This drug is used both systemically and topically for certain skin diseases (2, 4). Its effectiveness in treating rosacea, dermatitis perioralis, as well as acne inflammation, probably by inhibiting oxidative tissue injury in the presence of palmitoleic acid, has been reported (5, 6).…”