DESCRIPTION

Distinct papular eruption of perioral and/or periocular area found almost exclusively in women.

HISTORY

• Very common in women in their twenties and thirties. • Asymptomatic or mild itching. • Appearance is major complaint. • Persists for months. • May follow long-term use of moderate to strong topical steroids. • Often it is idiopathic.

PHYSICAL FINDINGS

• Pinpoint papules and pustules found typically adjacent to the angles of the mouth, on the chin, adjacent to the alar creases, and lateral ocular canthi. • May be limited to one of these areas. • May be mild scaling. • Lesions next to nostrils may be only manifestation. • Wide variability in intensity. Worst cases follow cessation of moderate to strong topical steroids. • Sometimes occurs lateral to eyes.

TREATMENT

A 2-6-week course of oral antibiotics is reliable and more effective than topical treatment. Re-treat or use long-term suppression for persistent actively.

• Tetracycline 250 or 500 mg b.i.d. • Doxycycline 50 mg, 75 mg, 100 mg b.i.d. • Minocycline 50 mg, 75 mg, 100 mg b.i.d. • Erythromycin 500 mg b.i.d. • Trimethoprim/sulfamethoxazole 80–400 mg, 160–800 mg b.i.d.

Topical medication may control disease or maintain remission when applied q.d. to b.i.d. Use mild preparations in this easily irritated area: • 10% sodium sulfacetamide (multiple brands) q.d. • Metronidazole: Noritate cream 1%, 30 g; Metrocream 0.75%, 45 g; metrolotion 0.75%, 59 mL; metrogel 1% 60 g; metronidazole 0.75%, gel 45 g, cream 45 g, lotion 59 mL. • Azelaic acid: Finacea gel 15%, 30 g, azelex cream 20%, 30 g, 50 g. • Clindamycin: Cleocin T gel 1%, 30 g, 60 g; Cleocin T 1%, lotion 60 mL; clindagel 1%, 40 mL, 75 mL; Clindamax lotion 1%, 60 mL; evoclin foam 1%, 50 g, 100 g. • Aczone gel 5%, 30 g, 60 g.

Avoid strong topical steroids, routine use of moisturizers and cosmetics.