Sunday, November 27, 2005

5 year old girl with perioral rash

This 5 year-old girl presents with a 5 month history of a dermatitis at angle of mouth and upper lip. There are areas of patchy erythema with scale and discrete acneiform papules. She has been treated with mupirocin cream, ketoconazole cream, and 1% HC cream. None of these have helped. She is not atopic, has no family history of atopy and is not a lip licker.
Althoug subtle, I think this is perioral dermatitis of childhood. Tetracycline is contraindicated. I wonder if systemic erythromycin would be helpful. Based on the literature, I started her on metronidazole cream and told her mother that this may take weeks to months to get better.
I would appreciate your suggestions.


4 comments:

  1. Interesting case. I would consider alternating topical tacrolimus with the metronidazole, and if not much improved after 1 month, consider adding oral erythromycin. Could consider photodynamic therapy as well if the child can sit still.

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  2. Agree with the diagnosis. In my estimation there is no drug with dramatic effect in this condition. The parents should know that it will take time to heal. I have not good experience with metronidazole (Generic)in this age, but tacrolimus works satisfactorily.

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  3. I always disregard this diagnosis in my teaching as perioral dermatitis is either over diagnosed or misdiagnosed or even misnomer??????.So in this present case ,I think the diagnosis is irritant dermatitis or even erythematous stage of pityriasis alba.Accordingly,the treatment is to stop all irritants on the face especially soaps and even frequent washing with water.Also to use emollients like vasaline.

    khalifa sharquie

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  4. I found some information about Perioral Dermatitis here. Check it out!

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