Childhood granulomatous periorificial dermatitis: case report and review of the literature.

Childhood granulomatous periorificial dermatitis (CGPD), considered a clinical variant of perioral dermatitis, typically affects prepubertal children of African descent. It is a condition of unknown etiology characterized by the presence of a monomorphic yellow-brown papular eruption limited to the perioral, perinasal, and periocular regions that histopathologically shows a granulomatous pattern. This disorder should be differentiated from other conditions as granulomatous rosacea, sarcoidosis, and lupus miliaris disseminatus faciei. We report a case of a 9-year-old boy who presented with flesh-colored perorificial papules on the face, evolving for two months. Upon treatment with topical tacrolimus for follicular eczema, an aggravation of the condition was observed. A skin biopsy confirmed the diagnosis of CGPD. Our patient was successfully treated with a combination of topical metronidazole and topical erythromycin.

Recalcitrant granulomatous periorificial dermatitis with good response to low-dose oral isotretinoin.

Granulomatous periorificial dermatitis is a clinical variant of periorificial dermatitis. We present the case of an 18-year-old girl with several reddish papular lesions in the perioral, perinasal, and periorbital regions unresponsive to conventional therapy. After 6 months of therapy with low-dose oral isotretinoin, the lesions fully remitted.

The pathogenetic role of rod-shaped bacteria containing intracellular granules in the vellus hairs of a patient with perioral dermatitis: A comparison with perioral corticosteroid-induced rosacea.

The cause of perioral dermatitis is still unknown. We previously reported that rod-shaped bacteria (RB) containing intracellular granules were detected in cases of perioral dermatitis at a high incidence. The aim of this study was to study further the role of RB in perioral dermatitis. Altogether 10 patients with perioral dermatitis and eight patients with perioral corticosteroid-induced rosacea, who were referred to our department from 2009 to 2014, were examined for the presence of RB, using the tape-stripping toluidine blue method. RB were detected on the surfaces of the roots of vellus hairs from lesions in nine of the 10 patients with perioral dermatitis. In contrast, RB were not detected in any of the eight patients with perioral corticosteroid-induced rosacea. No RB were found in the perioral areas of other types of facial dermatitis, including atopic dermatitis and seboerrheic dermatitis or in 16 healthy controls. We treated four of the patients with perioral dermatitis with minocycline hydrochloride and five with cefcapene pivoxil hydrochloride hydrate. Three of the patients with perioral dermatitis who were treated with minocycline hydrochloride were cured in 3 to 8 weeks, while the five patients treated with cefcapene pivoxil hydrochloride hydrate were cured in 2 to 9 weeks. These results strongly suggest that RB (possible fusobacteria) play an important role in perioral dermatitis and that this is probably a distinct clinical entity from corticosteroid-induced rosacea. Cefcapene pivoxil hydrochloride hydrate seems to be an effective treatment for perioral dermatitis associated with RB.

[Childhood granulomatous periorificial dermatitis]. / Granulomatöse periorifizielle Dermatitis der Kindheit.

CASE REPORT: A 14-year-old patient of African ancestry presented with multiple papules in the perioral, perinasal and periocular areas. Histopathology showed sarcoidal granulomas. DIAGNOSIS: After exclusion of systemic sarcoidosis, the diagnosis of childhood granulomatous periorificial dermatitis was made. THERAPY: Topical treatment with erythromycin resulted in complete regression. CONCLUSION: Childhood granulomatous periorificial dermatitis is mainly observed in dark-skinned children of African, Caribbean, or Asian origin. The nosological position of the dermatosis is controversial. Originally classified as sarcoidosis, childhood granulomatous periorificial dermatitis is now generally regarded as a special form of perioral dermatitis.

Periocular hyperpigmentation: a review of etiology and current treatment options.

BACKGROUND: Periocular "dark circles" fall among the most difficult chief complaints to address. In most cases, we have little information regarding etiology and no gold-standard treatment option. The extent of the problem is reflected in the sheer number of products on the market advertised to either lighten or cover the pigmentation. OBJECTIVE/METHODS: To present dermatologists with a complete review of the literature with regard to anatomy, definition, etiology, and treatment of periocular hyperpigmentation. CONCLUSIONS: Our understanding of the causes and treatment of periocular hyperpigmentation continues to advance. Nevertheless, we are in need of additional controlled clinical trials and novel therapeutic options. Individual patients will likely benefit most from a combination of approaches. Although more randomized clinical studies are necessary, Pfaffia paniculata/Ptychopetalum olacoides B./Lilium candidum L.-associated compound cream seems to be a promising option, with 90% improvement. For patients with increased melanin deposition, quality-switched ruby laser therapy could offer a better treatment option. In the hands of experienced professionals, a surgical option might be suitable, either by autologous fat transplantation or hyaluronic acid filler.

Periorificial dermatitis due to systemic corticosteroids in children: report of two cases.

Periorificial dermatitis is a common acneiform eruption that is thought to represent a variant of rosacea. These patients typically present with uniform erythematous papules most commonly located periorally but also occurring around the nose and eyelids. This eruption has been linked to topical corticosteroid use, with only a few reports in the literature associated with systemic steroid use in adults. Here, we report two cases of periorificial dermatitis occurring after systemic corticosteroid use in children.

Facial blaschkitis: case and review.

We report on a 15-year-old female with a 3-month history of a pruritic, erythematous cutaneous eruption on the right cheek and perioral area. The lesion had a linear distribution following the lines of Blaschko. Histopathological findings and direct immunofluorescence were compatible with chronic cutaneous lupus erythematosus (LE). Treatment with topical steroids and systemic antimalarial agents over 2 months showed hardly any improvement contrary to similar cases reported in the literature in the past. Histological findings move this case close to LE. However, the unusual clinical presentation as well as the resistance to antimalarial drugs do not fully allow to confirm this suspicion. Therefore, we recommend to call this new entity LE-like facial Blaschkitis of the adult.

Periocular milia en plaque successfully treated by erbium:YAG laser ablation.

Milia en plaque in the periocular region represent a cosmetically disturbing skin condition of unknown origin characterized by numerous tiny milia grouped around the inner canthus and the medial aspect of both eyelids. While conservative treatment and manual expression often result in local recurrence, invasive approaches harbor the risk of mechanical or thermal injury of periocular skin and lid margins. A 32-year-old female patient with refractory periocular milia was treated with the erbium:YAG laser and followed-up for 12 months. Ablative laser treatment led to nearly complete resolution of the milia and an excellent clinical result. Importantly, no scarring, dyspigmentation or ocular complications were noted. This report demonstrates the efficacy and safety of erbium:YAG laser ablation of periocular milia. The precise control of tissue ablation with minimal thermal damage makes the erbium:YAG laser an ideal tool for the treatment of the delicate periocular region where even minimal scarring can result in ocular complications.

Granulomatous Periorificial Dermatitis in an Adult: A case report with review of literature.

Granulomatous periorificial dermatitis (GPD) is a benign, self-limiting eruption that is considered a clinical variant of periorificial dermatitis, also known as perioral dermatitis. It presents primarily in prepubertal children as monomorphic scaly papules over perioral, paranasal and periorbital areas of the face with rare occurrence in adults. We report a 36-year-old Omani male patient who presented to the Dermatology Clinic at Bahla Polyclinic, Bahla, Oman, in 2018 with a papular eruption over his face for the previous six months. Based on clinical and histopathological findings the patient was diagnosed with GPD with sarcoid-like histology. He was treated effectively with oral doxycycline and topical metronidazole. This report provides a review of the literature on GPD and summarises all reported cases in adults to date.

Oral Granulomatous Disease.

Granulomatous diseases are chronic inflammatory disorders whose pathogenesis is triggered by an array of infectious and noninfectious agents, and may be localized or a manifestation of systemic, disseminated disease. As in the skin, oral manifestations of granulomatous inflammation are often nonspecific in their clinical appearance. Thus, in the absence of overt foreign material or a recognizable infectious agent, identifying the underlying cause of the inflammation can be challenging. This article highlights various conditions known to induce granulomatous inflammation within the oral soft tissues.

Cutaneous normolipemic plane xanthoma with supraglottic involvement in a patient with hand-Schüller-Christian Disease: a case report.

Normolipemic plane xanthoma (NPX) is a histiocytic disorder characterized by yellow-orange plaques in the periorbital areas, neck, upper trunk, and flexural folds. Association with systemic disease or paraproteinemia has been reported previously, but rarely with Langerhans cell histiocytosis (LCH). We report a case of Hand-Schüller-Christian disease (a type of LCH) in a patient who developed NPX with supraglottic involvement. NPX developed after several courses of chemotherapy and the supraglottic xanthoma occurred about 2 years later. The coexistence of LCH and non-LCH histiocytic lesions in this patient could be a result of chemotherapy-induced changes or may be just coincidental.

Perioral dermatitis.

Perioral dermatitis is an inflammatory facial skin disorder that predominantly affects women. It is rarely diagnosed in children. The etiology of perioral dermatitis is unknown; however, uncritical use of topical corticosteroids often precedes skin lesions. There is a written diagnostic work-up, differential diagnosis and treatment.

Short-term thallium intoxication: dermatological findings correlated with thallium concentration.

BACKGROUND: The dermatological features and skin biopsy findings of short-term thallium intoxication have been described. However, the correlation between the dermatological findings and the thallium concentration, the prognosis of peripheral neuropathy, and a cutaneous nerve biopsy study are lacking. OBSERVATIONS: Two patients initially developed perioral numbness, erythematous facial rashes, and polyneuropathy after ingesting thallium-containing water. Severe diffuse alopecia was noted, and a skin biopsy specimen revealed parakeratosis and vacuolar degeneration of the basal layer. Examinations of the hair mount demonstrated a tapered appearance of the anagen root. A serial cutaneous nerve biopsy study showed a loss of epidermal nerves 7 weeks and even 1 year after the thallium intoxication. A toxicology survey disclosed a high concentration of thallium (about 3124 mg/L) in the water. The clinical dermatological features subsided completely, but polyneuropathy with severe painful feet persisted. The blood and daily urinary thallium concentrations decreased slowly in the following 3-month period. CONCLUSIONS: The clinical dermatological features subsided completely, but painful polyneuropathy persisted. The series cutaneous nerve biopsy specimens showed persistent damage to the sensory nerve endings. The disappearance of the dermatological features and the appearance of Mees lines correlated with the decrease of blood and urinary thallium concentrations.

Periorificial dermatitis in children and adolescents.

BACKGROUND: There has been very little evaluation of the history, morphology, or disease course of perioral/periorificial dermatitis in children. OBJECTIVE: We sought to elucidate the clinical manifestations and treatment outcomes in this condition. METHODS: A retrospective chart review with telephone follow-up was used to study 79 children and adolescents. RESULTS: Patients ranged from 6 months to 18 years of age. The average duration of the rash at presentation was 8 months. Seventy-two percent had a history of topical, inhaled, or systemic steroid exposure. Seventy percent of patients had perioral involvement, 43% perinasal, and 25% periocular involvement. A perivulvar rash was reported in 1% of patients. Treatment with topical metronidazole was associated with clearing on follow-up examination. LIMITATIONS: This is a retrospective study without case controls and is subject to interviewer and memory bias. CONCLUSION: Perioral dermatitis appears at all ages in childhood and adolescence and may be associated with topical corticosteroid use. It may be responsive to topical metronidazole in children and adolescents and is more appropriately termed periorificial dermatitis.

Case of childhood granulomatous periorificial dermatitis in a Korean boy treated by oral erythromycin.

Childhood granulomatous periorificial dermatitis (CGPD) is a disease presenting most commonly in prepubertal children as yellow-brown papules limited to the perioral, perinasal and periocular regions. The condition is benign, self-limiting and is not associated with systemic involvement. We herein report a case of an 11-year-old Korean boy with multiple, asymptomatic, monomorphic, red-to-yellow-colored papular eruptions on the perioral areas of 7-month duration. Histopathological examination revealed upper dermal and perifollicular granulomatous infiltrate. After using oral erythromycin 500 mg daily for 1 year, the condition resolved completely without leaving a scar.

The use of topical azelaic acid for common skin disorders other than inflammatory rosacea.

Topical azelaic acid (AzA) is approved for the treatment of acne vulgaris and inflammatory (papulopustular) rosacea. Because of diverse mechanisms of action that correlate with potential therapeutic benefit, AzA has been used to treat several common dermatoses including acne vulgaris, inflammatory rosacea, erythematotelangiectatic rosacea, perioral dermatitis, melasma, and postinflammatory hyperpigmentation. This article reviews the therapeutic use of topical AzA for the treatment of common skin disorders other than the US Food and Drug Administration (FDA)-approved indications of acne vulgaris and inflammatory rosacea.