Evidence based review of perioral dermatitis therapy

Area of Science:

• Dermatology
• Dermatologic Therapeutics
• Evidence-Based Medicine

Background:

• Perioral dermatitis is a common facial rash characterized by erythematous papules and pustules, often affecting young women.
• Historically, oral tetracyclines were the primary treatment, but newer agents show promise.
• Identifying the most effective treatments based on robust evidence is crucial for clinical practice.

Purpose of the Study:

• To review and evaluate the strength of evidence for various published therapies for perioral dermatitis.
• To compare the efficacy of different treatment modalities based on available clinical data.

Main Methods:

• A comprehensive literature search was conducted using Pubmed and Cochrane Library databases.
• Included studies encompassed cases, case series, and clinical trials on perioral dermatitis treatment published in English.
• Data was analyzed to assess the evidence supporting each therapeutic approach.

Main Results:

• "Zero therapy" (discontinuing exacerbating agents like cosmetics and topical corticosteroids) is effective for self-limiting cases.
• Oral tetracyclines and topical erythromycin significantly shorten the time to papule resolution.
• Topical pimecrolimus rapidly improves disease severity, especially after corticosteroid use, though not necessarily time to complete resolution.
• Evidence for topical metronidazole is weaker, with trials showing it to be less effective than tetracycline.

Conclusions:

• The strongest evidence supports "zero therapy," topical pimecrolimus, oral tetracycline, and topical erythromycin for managing perioral dermatitis.
• Treatment choice should consider the strength of supporting evidence and individual patient factors.
• Further research may clarify the role of other agents and optimize treatment strategies.