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Periorificial dermatitis in infants and preschoolers - a narrative review
Anca Chiriac1,2,3, Anca E Chiriac4, Bhushan Madke5
1Department of Dermatology, Nicolina Medical Center, Iasi, Romania.
Insights
Periorificial dermatitis (POD) in children is a clinical diagnosis presenting as red papules. Treatment avoids tetracyclines in young children, favoring topical or oral erythromycin.
Area of Science:
- Dermatology
- Pediatric Dermatology
- Inflammatory Skin Diseases
Background:
- Periorificial dermatitis (POD) is a chronic inflammatory skin condition.
- It commonly affects women aged 20-40, with differential diagnosis including persistent acne.
- POD is less frequent in children, and rare in infants and preschoolers.
Purpose of the Study:
- To conduct a narrative review of periorificial dermatitis in children aged 6 years and younger.
- To outline diagnostic criteria and clinical presentation in pediatric populations.
- To review current and emerging treatment strategies for pediatric POD.
Main Methods:
- Narrative review of existing literature on pediatric periorificial dermatitis.
- Analysis of clinical presentation, diagnostic challenges, and treatment outcomes.
- Focus on age-specific considerations, particularly contraindications for certain medications.
Main Results:
- Diagnosis of POD in children is primarily clinical, characterized by monomorphic erythematous papules.
- The granulomatous subtype is more prevalent in younger children compared to adults.
- Key differential diagnoses include atopic dermatitis, seborrheic dermatitis, pediatric rosacea, juvenile acne, and cutaneous sarcoidosis.
Conclusions:
- Topical metronidazole or erythromycin and oral erythromycin are common treatments for pediatric POD.
- Tetracyclines are contraindicated in infants and preschoolers due to potential adverse effects on bone and teeth development.
- Further research, including randomized controlled trials, is needed for optimal management of pediatric POD, with JAK inhibitors showing future promise.
Abstract:
Periorifical dermatitis (POD) is a papular, chronic inflammatory skin disease commonly seen in women in their 2nd to 4th decade of life. The major differential diagnosis is persistent acne. In children, POD is less common than in adults. In infants and preschoolers POD is rare. We performed a narrative review for POD in children ≤6 years of age. Diagnosis is clinical. The disease presents with monomorphic erythematous papules that usually leave a 1-2 mm Grenz zone around the red lips unaffected. Perinasal skin, nostrils and eyelids can be involved, while extrafacial manifestations are rare. The granulomatous subtype of POD is more common in small children that in adults. The most important differential diagnoses in children include atopic and seborrheic dermatosis, pediatric rosacea, juvenile acne, and cutaneous sarcoidosis. While topical macrolides, azelaic acid, and calcineurin inhibitors are often used in mild cases of adult POD, oral tetracyclines are the treatment of choice in more advanced cases. In infants and preschoolers, tetracycline should be avoided since they can affect the calcification (hardening) of the bones and teeth and lead to permanent discoloration of teeth. There are no randomized controlled trials for POD in this age group available. Topical metronidazole or erythromycin and oral erythromycin are most used. New drugs like JAK inhibitors are on the horizon.
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