Perioral dermatitis: Diagnosis, proposed etiologies, and management.

BACKGROUND AND AIMS: Perioral dermatitis is a common cutaneous condition characterized by acneiform facial eruptions often with an eczematous appearance. A granulomatous subtype exists in addition to the classic variant. While topical corticosteroids have been largely implicated in this condition, its etiology is not completely understood. METHODS: Using the keywords "corticosteroids," "dermatology," "fusobacteria," "perioral dermatitis," and "periorificial dermatitis," we searched the databases PubMed, MEDLINE, and EMBASE to find the relevant literature. Only articles in English were chosen. The level of evidence was evaluated and selected according to the highest level working our way downwards using the Oxford Centre of Evidence-Based Medicine 2011 guidance. RESULTS: This systematic review found the strongest evidence to support topical corticosteroid misuse as the principal causative factor in the pathogenesis of perioral dermatitis. CONCLUSION: In terms of treatment, further research is required to robustly investigate promising treatment options including tetracyclines, topical metronidazole, topical azelaic acid, adapalene gel, and oral isotretinoin.

A Practical Approach to Recalcitrant Face and Neck Dermatitis in Atopic Dermatitis.

Face and neck dermatitis in the atopic dermatitis patient is a diagnostically challenging entity with broad differential diagnoses. Recent case reports reporting face and neck dermatitis in patients on dupilumab therapy have added further complexity to diagnosis and management. Herein, we discuss a broad diagnostic algorithm and practical management strategy for recalcitrant face and neck dermatitis in the atopic patient with an emphasis on face and neck dermatitis associated with dupilumab therapy. Our aim is to raise awareness about the probable entity of drug-associated face and neck dermatitis and share a practical management strategy that may also be applied broadly to atopic dermatitis patients presenting with face and neck dermatitis.

Clinical findings and outcomes for dogs with uveodermatologic syndrome.

OBJECTIVE To evaluate signalment, clinical signs, treatment, and factors affecting visual prognosis in dogs with uveodermatologic syndrome (UDS). DESIGN Retrospective case series and nested cohort study. ANIMALS 50 dogs (37 Akitas and 13 non-Akitas) with UDS evaluated at 4 ophthalmology practices. PROCEDURES Data were collected from the medical records regarding signalment, clinical signs, biopsy results, medications, adverse effects, vision and glaucoma status at initial and subsequent examinations, and duration of follow-up. Various factors were examined for associations with development of blindness or glaucoma following initial examination. RESULTS The most common ophthalmic signs included aqueous flare (n = 35 [70%]), iris abnormalities (29 [58%]), retinal detachment (23 [46%]), and choroidal depigmentation or chorioretinal infiltrates (10 [20%]). At initial examination, 36% (18/50) of dogs had glaucoma and 57% (26/46) were blind in both eyes. Twenty-five (50%) dogs had vision at their final visit, representing 78% of the 32 dogs that had vision at initial examination or regained vision during the follow-up period. In dogs that lost vision, median time to permanent blindness in both eyes was 13.5 months (range, 0.4 to 59 months) after initial examination. No significant associations with time to glaucoma or vision loss were identified for signalment variables, specific medications, or duration of clinical signs prior to initial examination. CONCLUSIONS AND CLINICAL RELEVANCE UDS commonly resulted in glaucoma, vision loss, or both in affected dogs. No evaluated factor was associated with visual prognosis; however, a subset of patients maintained vision through to the final recheck examination.

[Granulomatous periocular eruption]. / Dermatite périoculaire granulomateuse.

BACKGROUND: Herein, we report a case of atypical periorificial dermatitis in a patient that had been receiving treatment for some time for atopic dermatitis. The specific feature of this rash was its periocular predominance with no perioral involvement, its clinical aspect and its histological picture evocative of sarcoidosis. PATIENTS AND METHODS: A 33-year-old man was being treated for a atopic dermatitis limited to the face and poorly responsive to dermal corticosteroids. Treatment was initiated with topical tacrolimus 0.1%. After 4 years, dependence on this treatment was noted, with daily application being needed to control the lesions. One year later, symmetric lesions were seen on the eyelids and periorbital regions; these were erythematous, micropapular and poorly delineated in a setting of oedema. Biopsy revealed epithelioid granulomatous inflammation, and, to a lesser degree, sarcoidal giant-cell features without caseous necrosis. Staging tests to identify systemic sarcoidosis were negative. Treatment with hydroxychloroquine at 400mg per day and discontinuation of topical tacrolimus resulted in complete remission of the lesions within 2 months. Hydroxychloroquine was discontinued after 6 months, and no relapses had occurred after 2 years of follow-up. DISCUSSION: Three diagnostic hypotheses may be posited for these granulomatous facial lesions. We opted for a diagnosis of granulomatous periorificial dermatitis despite the fact that exclusively periorbital involvement is rare (this condition is generally associated with perioral dermatitis). The second was that of pure cutaneous sarcoidosis, but the topography and clinical appearance of the lesions did not correspond to any of the cutaneous forms classically described. The third was that of tacrolimus-induced granulomatous rosacea, but the histological picture is different. CONCLUSION: The present case underscores the fact that a histological appearance of sarcoidosis on skin biopsy may be associated with perioral dermatitis.

Pediatric periorificial dermatitis.

Periorificial dermatitis (POD) has been documented in the pediatric population in patients as young as 3 months, with a slight predominance in girls compared to boys. Many patients have a personal or family history of atopic disorders. Periorificial dermatitis typically presents with erythematous to flesh-colored papules and rarely pustules near the eyes, nose, and mouth. Although the etiology is unknown, many patients have had recent exposure to a topical or less commonly an inhaled or systemic corticosteroid. Although steroids may initially control the skin lesions, disease often rebounds after discontinuing therapy. Diagnosis of POD is clinical. Laboratory tests are not helpful in making the diagnosis, and the histology of POD resembles rosacea. It is important to rule out other acneform diagnoses based on the age of the patient, clinical history, and presentation of the lesions. Topical metronidazole has been successful in the pediatric population. For pediatric patients with extrafacial skin lesions or more severe disease, oral antibiotics such as tetracycline, doxycycline, minocycline, azithromycin, and erythromycin can be used, depending on the age of the patient.

Granulomatous Rosacea and Periorificial Dermatitis: Controversies and Review of Management and Treatment.

Granulomatous rosacea and periorificial dermatitis are common skin conditions affecting the face. This article examines the historical origin, causes, clinical presentation, and management strategies for these entities.

Perioral dermatitis.

Perioral dermatitis is a relatively common inflammatory facial skin disorder that predominantly affects women. It is rarely diagnosed in children. A typical perioral dermatitis presentation involves the eruption of papules and pustules that may recur over weeks to months, occasionally with fine scales. The differential diagnosis includes seborrheic dermatitis, systemic lupus erythematosus, acne vulgaris, lupus miliaris disseminatus faciei, polymorphous light eruption, steroid-induced rosacea, granulomatous perioral dermatitis, contact dermatitis (allergic and irritant), and even basal cell carcinoma. The histopathology is similar to that of rosacea, with a perivascular and perifollicular lymphohistiocytic infiltrate and sebaceous hyperplasia. The etiology of perioral dermatitis is unknown, but the uncritical use of topical corticosteroids often precedes skin lesions. Physical sunscreens with high sun protection factors may cause perioral dermatitis in children.

Dermatitis perioral en la infancia: presentación de dos casos e importancia de la correlación clínico patológica / Perioral dermatitis in childhood: report of two cases and importance of clinical pathological correlation

Con el nombre de dermatitis periororal se conocen a un grupo de dermatosis inflamatorias y eruptivas que predominan en mujeres jóvenes, y con menos frecuencia en niños. Se caracterizan por pápulas y pústulas pequeñas en una distribución periorificial, predominantemente alrededor de la boca. Puede estar relacionada con el uso de esteroides tópicos. Se presentan dos casos clínicos: Caso 1. Paciente de sexo masculino, de 12 años de edad, con lesiones papulopustulares periorales, de un mes de evolución. Se realizó el diagnóstico de foliculitis por Malassezia sp. en base a la histopatología y la tinción de Gram. Se dio tratamiento con Itraconazol, 200 mg, por vía oral, durante 14 días (5 mg/kg), y crema de ketoconazol al 2%, dos veces al día. Se obtuvo resolución completa en dos meses. Caso 2. Paciente de sexo femenino, de nueve años de edad, con dos meses de evolución con pápulas periorales tratadas con betametasona, con posterior diseminación a nariz y párpados. Se realizó diagnóstico de dermatitis granulomatosa periorificial en base a la histopatología y tinción de Gram. Se inició tratamiento con eritromicina, vía oral, y metronidazol, gel 1%. Se observó resolución casi completa en seis semanas. Ambos casos muestran que el diagnóstico, la etiología y el manejo de dermatitis periorales en niños son un verdadero reto, por lo tanto es de crucial importancia realizar una correlación clínico patológica.

Perioral dermatitis was described as an inflammatory rash in young women, but also present in children. It is characterized by periorificial papules and pustules predominantly around themouth. It can be related with the use of topical corticosteroids. We report two cases: A 12 year-old male patient, with a one month history of perioral papulopustular lesions. Diagnosis offolliculitis Malassezia sp. was supported on histopathology and Gram stain. Itraconazole therapy was given, 200 mg orally for 14 days (5 mg/kg) and ketoconazole cream 2% twice daily. Complete resolution was obtained within two months. A 9 year-old female patient, with a two months history of perioral papules treated with betamethasone, later spreading to nose and eyelids. Diagnosis of periorificial granulomatous dermatitis was based on histopathology and Gram stains. Treatment with oralerythromycin and metronidazole gel 1%, showed an important improvement after six weeks. Both cases show that the diagnosis, etiology and management of perioral dermatitis in children is a challenge, so it is crucial to make a clinic pathologic correlation.