Perioral dermatitis is an inflammatory rash that affects the skin around the mouth (sometimes the nose and eyes). In children, it is often linked to topical steroid creams, fluoridated toothpaste, or occlusive skin products.
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✅ Introduction
Perioral dermatitis (also known as periorificial dermatitis) presents as clusters of red papules, sometimes with pustules, sparing a narrow zone next to the lips. Although more common in adults, it is also seen in children and requires treatments tailored for pediatric safety.
✅ Causes and triggers
° Topical corticosteroid creams (e.g., hydrocortisone) — the most common trigger.
° Occlusive moisturizers, cosmetics, fluoridated toothpaste, nasal steroid sprays, and inhalers.
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° Clinical appearance: red papules around the mouth with “grenz zone” of normal skin next to lips.
° Pediatricians/dermatologists may rule out eczema, acne, or rosacea if symptoms persist.
✅ First-line management (parent steps)
1. Stop topical steroids on the face (gradual withdrawal under medical supervision).
2. Discontinue heavy creams, cosmetics, or fluoride toothpaste if suspected. Use gentle cleansers.
3. Avoid scratching, squeezing, or harsh products — “zero therapy” (minimal skincare) often helps.
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Important: Only a pediatrician/dermatologist should prescribe these.
° Metronidazole topical (brands: MetroGel, Noritate): 0.75–1%, apply twice daily (BID) for several weeks. First-line topical.
° Azelaic acid 20% cream (brand: Azelex; Finacea 15% gel for adults): shown effective in children, applied once or twice daily for 4–8 weeks.
° Clindamycin topical (Cleocin T 1%): alternative topical option.
° Tacrolimus/pimecrolimus creams: steroid-sparing agents used off-label in resistant cases.
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Reserved for moderate–severe or resistant cases.
° Erythromycin oral (Erythrocin, E-Mycin): 30–50 mg/kg/day, divided every 6–8 h. Common pediatric alternative since tetracyclines are contraindicated in young children.
° Azithromycin oral (Zithromax): pediatric regimen 10–12 mg/kg on day 1, followed by 5–10 mg/kg for 3–5 days.
° Tetracyclines (doxycycline, minocycline): effective in adults, but contraindicated in children younger than 8 to 12 years due to risks for teeth and bone.
* Disclaimer: Scientific evidence indicates that the use of certain antibiotics, such as tetracyclines, should be avoided in young children due to the risk of dental alterations. Some sources set the limit at under 8 years of age, while others extend the recommendation up to 12 years. Given this variability, parents are advised to always consult a specialist before starting treatment.
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° Average improvement: 4–8 weeks.
° If no response after 8 weeks, re-evaluation is needed.
💬 Discussion
° The key intervention is removing triggers, especially topical steroids. Withdrawal may temporarily worsen symptoms (rebound), but healing occurs in weeks.
° In children, systemic antibiotics (erythromycin, azithromycin) should be prescribed cautiously due to side effects and resistance risk.
° Azelaic acid 20% has shown safety and effectiveness in pediatric cases, making it a strong alternative when avoiding antibiotics.
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1. If your child develops red papules around the mouth, seek medical advice.
2. Avoid steroid creams on the face — they worsen perioral dermatitis.
3. Safe options include metronidazole topical (0.75–1% BID) and azelaic acid 20% cream; oral erythromycin 30–50 mg/kg/day is reserved for more severe cases.
4. Gentle skincare and patience usually lead to improvement within weeks.
📝 References
✔ StatPearls Authors. (2024). Perioral Dermatitis. StatPearls. NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK525968/
✔ Jansen, T. (2004). Azelaic acid as a new treatment for perioral dermatitis: results from an open study. British Journal of Dermatology, 151(4), 933–934. https://pubmed.ncbi.nlm.nih.gov/15491447/
✔ Medscape. (2024). Perioral Dermatitis — Treatment & Management. EMedicine. https://emedicine.medscape.com/article/1071128-treatment
✔ Merck Manual Professional Version. (2024). Perioral Dermatitis. https://www.merckmanuals.com/professional/dermatologic-disorders/acne-and-related-disorders/perioral-dermatitis
✔ Drugs.com. (2025). Metronidazole Topical Dosage & Information. https://www.drugs.com/mtm/metronidazole-topical.html
✔ DermNet NZ. (2024). Periorificial dermatitis in children. https://dermnetnz.org/topics/periorificial-dermatitis-in-children/
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