Perioral dermatitis treatment

Perioral dermatitis is sometimes also called Perioral-nasal-ocular dermatitis (PONOD) or periorificial dermatitis, because the rash can also appear around the nose and eyes.

Perioral dermatitis is associated with the use of facial products. Most patients with Perioral dermatitis are using multiple different types of facial products. The use of corticosteroid containing creams over extended periods are strongly linked to the development of Perioral dermatitis. One of the most important aspects of the treatment of Perioral dermatitis is therefore the gradual elimination of all non-essential facial products.

Depending on the severity of the Perioral dermatitis the above process is started while taking an oral Tetracycline antibiotic, like Minocycline, Doxycycline or Lymecycline. Normally this antibiotic must be continued for at least 3 months (or until the rash has disappeared) and is then tapered off over a 2 month period.

Paradoxically, the early phases of the treatment of Perioral dermatitis might involve using a mild topical corticosteroid cream on the face to calm down the active redness and inflammation. The most commonly used corticosteroid cream contains Mometasone furoate. This is initially applied daily until the redness subsides and then tapered off as soon as possible.

The tapering off process of the corticosteroid cream normally occurs over a few weeks. The average patient will use the corticosteroid cream daily for about 5 days, on alternate days for about 4 days, twice a week for about 2 weeks and after that maybe once or twice a month. There is however considerable variation.

While the corticosteroid cream is tapered off the oral antibiotic is continued until the rash has been absent for at least a month. Only then is the oral antibiotic also tapered off. It is extremely important that during this treatment period all non essential facial products (yes all!) must be gradually eliminated. If this is not entirely possible then try to eliminate as many facial products as you can. Only after all facial products have been stopped and the Perioral dermatitis has been clear for at least one month, can facial products be gradually reintroduced one by one.

Perioral dermatitis is normally quite responsive to the above treatment regime and most patients will experience a marked improvement in only a few days to weeks.

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