| • | predominantly affecting females of childbearing years |
clinical:
| • | the eruption starts unilaterally in the nasolabial fold are, frequently spreading to become symmetric |
| • | characteristically sparing a rim at the vermilion border |
| • | glabella, eyelids and even forehead may be affected |
| • | erythema, papulosis, and scaling |
ddx:
| • | rosacea (telangiectasia, perhaps the hallmark of rosacea, is not present in PD; though differences less distinct after topical glucocorticoid use) |
| • | seborrheic dermatitis (involvement of upper lip and chin rare in seb derm) |
| • | papular sarcoid (different distribution, monomorphic, and histology) |
treatment:
| • | children - oral erythromycin/azithromycin X 3 months |
| • | adults - minocycline 100mg PO BID x 1 to 2 weeks melts perioral dermatitis away in > 90% of cases (in my experience) |
| • | topical metronidazole, erythromycin, Elidel |
| • | recalcitrant cases - topical or oral ivermectin (single dose 250 ug/kg) |
this dermatologist uses:
| • | minocycline 100mg QD or BID (usually clears in one or two weeks) |
| • | can add elidel cream (or cleocin T lotion if Elidel is too expensive) as a topical |
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