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Perioral Dermatitis — SCE Dermatology MCQ

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EasyInflammatory DermatosesPerioral DermatitisSCE Dermatology

A 28-year-old woman presents with perioral dermatitis. She has erythematous papules and pustules around her mouth with a characteristic clear zone immediately adjacent to the vermilion border. She has been using potent topical corticosteroid on her face prescribed by her GP. What is the recommended management?

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Correct answer: E — Gradually withdraw the topical corticosteroid and start oral Tetracycline

Perioral dermatitis is often caused or exacerbated by topical corticosteroid use on the face. The pathognomonic clear zone sparing the vermilion border distinguishes it from other perioral dermatoses. Management involves gradual withdrawal of the topical corticosteroid (abrupt cessation may cause rebound flare) and starting oral Tetracycline (Lymecycline or Doxycycline) for 6-12 weeks. Topical Metronidazole or Azelaic acid can be used as steroid-sparing alternatives. A topical calcineurin inhibitor may be used during steroid withdrawal to manage rebound. Continuing or escalating topical steroids perpetuates the condition.

Reference: BAD 2019 Patient Information; NICE CKS