Dawaa Reference

chronic

Perioral Dermatitis

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources6 sources

BAD Guidelines for Management of Rosacea and Perioral Dermatitis 2021 · Rozex 0.75% w/w Gel SmPC sections 4.2 and 4.4 (eMC product 925) · Egyptian National Drug Formulary, antimicrobial 2023, erythromycin topical monograph · Isotretinoin 10 mg capsules, soft SmPC sections 4.3 and 4.4 (eMC product 100769) · Perioral Dermatitis - StatPearls - NCBI Bookshelf (NBK525968), corroborated by Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph) · Perioral Dermatitis - StatPearls - NCBI Bookshelf (NBK525968), with the 250 mg capsule form from Egyptian National Drug Formulary - Antimicrobial 2023 (tetracycline monograph)

Verified against5 documents
  • Rozex 0.75% w/w Gel SmPC sections 4.2 and 4.4 (eMC product 925)
  • Egyptian National Drug Formulary, antimicrobial 2023, erythromycin topical monograph
  • Perioral Dermatitis - disease-level clinical article (perioral-dermatitis-full.txt)
  • Perioral Dermatitis - disease-level clinical article (perioral-dermatitis-clinical.txt)
  • Isotretinoin 10 mg capsules, soft SmPC sections 4.3 and 4.4 (eMC product 100769)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (1)

  • Patients often describe burning or sensitivity in the rash, sometimes itching, and worsening with certain skincare products [itching · rash]

Signs — what you find (4)

  • Grouped red papules cluster around the mouth, eyes, and nose while sparing the vermilion lip edge [papules]
  • The granulomatous form shows flesh-colored to yellow-brown papules that can rarely extend to the neck, scalp, or trunk [papules]
  • The lupoid variant shows dense red-brown papules with a lupoid pattern seen on diascopy [papules]
  • Coexisting blepharitis or conjunctivitis in the granulomatous form warrants an eye evaluation

Tests (2)

  • Diagnosis is usually clinical, with skin biopsy reserved for atypical cases or a poor response to treatment
  • A KOH scraping is done when Candida is suspected as a contributing factor

If not this — what else fits (7)

  • Telangiectatic erythema with flushing on the central face points toward rosacea rather than acne
  • The presence of comedones and involvement of the chest or back favors acne vulgaris over perioral dermatitis
  • Widespread lesions plus systemic symptoms suggest sarcoidosis, confirmed with biopsy
  • Greasy scaling on the eyebrows, nasolabial folds, and scalp points toward seborrheic dermatitis instead
  • Involvement of the vermilion lip border itself, rather than sparing it, points to irritant cheilitis instead
  • Microscopy of unroofed pustules showing abundant mites points to Demodex folliculitis
  • Annular scaling plaques ruled out with a KOH prep point toward tinea faciei instead

SourceStatPearls "Perioral Dermatitis" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | Oral antibiotic when the topicals fail or the rash is extensive | Cheapest oral tetracycline if doxycycline is out of reach

MAIN TREATMENT - choose one

1

METRONIDAZOLE

1st line

Formtopical

Adult dose and duration

Apply 0.75% gel/cream twice daily to clean skin x 3 to 4 months

Paediatric dose

Not recommended in children (safety and efficacy not established).

Dose source

Rozex 0.75% w/w Gel SmPC sections 4.2 and 4.4 (eMC product 925)

Why

Topical metronidazole has antimicrobial and anti-inflammatory action that helps clear perioral dermatitis once all facial corticosteroids, the usual trigger, have been stopped.

Cautions
  • ZERO TOLERANCE: Immediately stop ALL topical corticosteroids on face (primary precipitating factor).
  • Warn patient of initial rebound flare when stopping topical steroids.
  • Avoid harsh facial cleansers, cosmetics, and fluorinated toothpastes.
  • Rosacea takes time - the label puts the average course at three to four months, and it may be continued beyond that if it is clearly working. Keep treated skin out of the sun.
Egyptian brands
Egyptian brandManufacturerIndicative price
ROSAGEL 0.75% GEL 20 GMEVA PHARMA11.50 EGP
FIPCODAZOLE 10 MG GELD B K > BOSTON HEALTH62.00 EGP
2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Perioral Dermatitis - disease-level clinical article (perioral-dermatitis-full.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - Topical corticosteroids should not be used for perioral dermatitis - they can trigger or worsen it, and cause a rebound flare if withdrawn abruptly. A clinically important pitfall, since steroids are a classic cause of this condition.
3

ERYTHROMYCIN

2nd line

Formtopical

Adult dose and duration

Apply 2% solution/gel twice daily x 6-8 weeks

Paediatric dose

Apply twice daily after washing face

Dose source

Egyptian National Drug Formulary, antimicrobial 2023, erythromycin topical monograph

Why

Topical erythromycin is a macrolide antibiotic used as an alternative to metronidazole for perioral dermatitis in patients who cannot tolerate it.

Cautions
  • Both packs listed below are withdrawn. Ask instead for ACNE BIOTIC PAINT or ACNE ZINC TOPICAL SOLUTION, which are erythromycin with zinc acetate and are still marketed - they do not appear in the list because the national file records no route for them. Egypt has no plain topical erythromycin, and the other live combinations add isotretinoin or salicylic acid, neither of which belongs on an inflamed face.
  • Erythromycin is an effective topical antibiotic alternative for metronidazole-intolerant patients.
  • Gentle skincare with soap-free cleanser is essential.
  • If refractory, consider oral doxycycline 100 mg daily for 6-8 weeks (adults only).
  • Topical erythromycin alone breeds resistance. Pair it with something else rather than running it as the only agent, and stop at 6-8 weeks if nothing has changed.
Egyptian brands
Egyptian brandManufacturerIndicative price
AKNEMYCIN 2% OINT. 15 GMdiscontinuedMUP > HERMAL-GERMANY5.00 EGP
ACNI-CARE 2% TOP. GEL. 20 GMdiscontinuedSIGMA6.50 EGP
4

ISOTRETINOIN

3rd line

Formoral.solid

Adult dose and duration

initially 0.2 mg/kg per day, tapering to 0.1 to 0.05 mg/kg per day

Paediatric dose

Isotretinoin should not be used for the treatment of prepubertal acne and is not recommended in children less than 12 years of age due to a lack of data on efficacy and safety. That sentence is the Isotretinoin 10mg Capsules, soft SmPC section 4.2, verbatim.

Dose source

Perioral Dermatitis - disease-level clinical article (perioral-dermatitis-clinical.txt)

Why

Low-dose oral retinoid reserved for severe or recalcitrant perioral dermatitis unresponsive to topical and oral antibiotic therapies.

Cautions
  • Teratogenic: strictly contraindicated in pregnancy; highly effective contraception required.
  • Monitor liver enzymes and fasting serum lipids on a schedule. Label verbatim (Isotretinoin 10 mg capsules SmPC section 4.4): "Liver enzymes should be checked before treatment, 1 month after the start of treatment, and subsequently at 3 monthly intervals unless more frequent monitoring is clinically indicated." and "Serum lipids (fasting values) should be checked before treatment, 1 month after the start of treatment, and subsequently at 3 monthly intervals unless more frequent monitoring is clinically indicated."
  • CONTRAINDICATED beyond pregnancy, same label section 4.3: "With hepatic insufficiency" (<meta name="description" content="Isotretinoin 10 mg capsules, soft SmPC, eMC product 100769), "With excessively elevated blood lipid values" (<meta name="description" content="Isotretinoin 10 mg capsules, soft SmPC, eMC product 100769), "With hypervitaminosis A" (<meta name="description" content="Isotretinoin 10 mg capsules, soft SmPC, eMC product 100769), and "Receiving concomitant treatment with tetracyclines" (<meta name="description" content="Isotretinoin 10 mg capsules, soft SmPC, eMC product 100769).
Egyptian brands
Egyptian brandManufacturerIndicative price
ROACCUTREX 10 MG 30 CAPS.MEDIZEN PHARMACEUTICAL INDUSTRIES > EGYPHARMA-EGYPT87.00 EGP (2.90/unit)
ROACCUTANE 10 MG 30 CAPS.F.HOFFMAN LA ROCHE126.00 EGP (4.20/unit)
ROACCUTREX 20 MG 30 CAPS.MEDIZEN PHARMACEUTICAL INDUSTRIES > EGYPHARMA-EGYPT161.00 EGP (5.37/unit)
ACNELOFIX 20 MG 20 CAPS.MELANO PHARMA270.00 EGP (13.50/unit)
ISOTRETAM 10 MG 20 S.G. CAPS.MEDIZEN115.00 EGP
ISOTRETINOIN 10MG 30 SOFT GELATIN CAPS.SUN PHARMA EGYPT LIMITED > RANBAXY192.00 EGP
ISOTRETINOIN 20MG 30 SOFT GELATIN CAPS.SUN PHARMA EGYPT LIMITED > RANBAXY372.00 EGP
NETLOOK 40MG 20 SOFT GELATIN CAPSULEMEDIZEN PHARMACEUTICAL INDUSTRIES > ANDALOUS PHARMA394.00 EGP

ORAL ANTIBIOTIC WHEN THE TOPICALS FAIL OR THE RASH IS EXTENSIVE

5

DOXYCYCLINE

Oral antibiotic when the topicals fail or the rash is extensive

2nd line

Strength100 mg

Formoral.solid

Adult dose and duration

100 mg once or twice a day, swallowed with plenty of water and not lying down afterwards x 8 to 12 weeks, tapering the dose down over the course

Paediatric dose

Not for children younger than 8 - tetracyclines are contraindicated in that age group, and the article names it as a reason to use erythromycin instead.

Dose source

Perioral Dermatitis - StatPearls - NCBI Bookshelf (NBK525968), corroborated by Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph) - verbatim: "Oral: IR and most ER formulations: 100 to 200 mg/day in 1 to 2 divided doses."

Why

Perioral dermatitis that has not answered topical metronidazole or erythromycin needs a systemic tetracycline before anyone considers isotretinoin. Doxycycline is the easiest of them to take, once or twice daily rather than four times.

Cautions
  • Contraindicated in children under 8, in the second and third trimesters of pregnancy, and while breastfeeding.
  • It photosensitises, which matters on a Cairo face - warn about sun exposure and advise a sunscreen for the whole course.
  • Swallow it with a full glass of water and stay upright afterwards, or it can ulcerate the oesophagus.
  • Antacids, calcium, iron and magnesium block its absorption - separate them by several hours.
Egyptian brands
Egyptian brandManufacturerIndicative price
FARCODOXIN 100MG 10 CAPS.PHARCO11.00 EGP (1.10/unit)
DOXY M.R.100 MG 10 CAPS.ADWIA12.00 EGP (1.20/unit)
GRANUDOXY 100MG 10 F.C. TAB.GLOBAL NAPI PHARMACEUTICALS > PIERRE FRANCE12.00 EGP (1.20/unit)
DOXYDOX 100 MG 10 CAPS.EIPICO23.00 EGP (2.30/unit)
DOXYMYCIN 100 MG 10 CAPS.EL NILE.30.00 EGP (3.00/unit)
TABOCINE 100MG 10 CAPS.TABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA46.00 EGP (4.60/unit)
VIBRAMYCIN 100MG 10 CAPS.PFIZER65.00 EGP (6.50/unit)

CHEAPEST ORAL TETRACYCLINE IF DOXYCYCLINE IS OUT OF REACH

6

TETRACYCLINE

Cheapest oral tetracycline if doxycycline is out of reach

2nd line

Strength250 mg

Formoral.solid

Adult dose and duration

250 to 500 mg twice a day on an empty stomach x 8 to 12 weeks, tapering the dose down over the course

Paediatric dose

Not for children younger than 8 - tetracyclines are contraindicated in that age group, and the article names it as a reason to use erythromycin instead.

Dose source

Perioral Dermatitis - StatPearls - NCBI Bookshelf (NBK525968), with the 250 mg capsule form from Egyptian National Drug Formulary - Antimicrobial 2023 (tetracycline monograph)

Why

Same class and same course as doxycycline but a fraction of the price, which decides it for many patients in Cairo. The trade-off is a strict empty-stomach schedule that patients keep less well.

Cautions
  • Contraindicated in children under 8, in the second and third trimesters of pregnancy, and while breastfeeding.
  • Take it on an empty stomach, and never with milk, antacids, calcium or iron, which bind it and stop it working.
  • It photosensitises - warn about sun exposure over an 8 to 12 week course.
  • Avoid it in renal impairment; unlike doxycycline it accumulates when the kidneys are poor.
Egyptian brands
Egyptian brandManufacturerIndicative price
TETRACYCLINE HCL 250 MG 16 CAPS. USP 24EL NASR11.00 EGP (0.69/unit)
TETRACID 250 MG 16 CAP.CID22.00 EGP (1.38/unit)
TETRACYCLINE 250 MG 12 CAPS. (ADCO)ARAB DRUG COMPANY (ADCO)16.50 EGP (1.38/unit)
TETRACYCLINE 250 MG 240 CAPS. (ADCO)ARAB DRUG COMPANY (ADCO)462.00 EGP (1.93/unit)

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.