# Perioral Dermatitis - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - 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) ## Treatment metadata - Metronidazole — topical - Referral & safety-netting (no drug therapy) - Erythromycin — topical - Doxycycline — 100 mg — oral.solid - Tetracycline — 250 mg — oral.solid - Isotretinoin — oral.solid ## Complete treatment card ```text PERIORAL DERMATITIS 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) Review status: REVIEWED against 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) (2026-08) 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 Source StatPearls "Perioral Dermatitis" - disease-level clinical article Status 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] Adult Apply 0.75% gel/cream twice daily to clean skin x 3 to 4 months Peds Not recommended in children (safety and efficacy not established). 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. Caution 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. Egypt ROSAGEL 0.75% GEL 20 GM EVA PHARMA 11.50 EGP FIPCODAZOLE 10 MG GEL D B K > BOSTO... 62.00 EGP 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult 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. Caution 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] Adult Apply 2% solution/gel twice daily x 6-8 weeks Peds Apply twice daily after washing face 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. Caution 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. Egypt AKNEMYCIN 2% OINT. 15 GM MUP > HERMAL-... 5.00 EGP [discontinued] ACNI-CARE 2% TOP. GEL. 20 GM SIGMA 6.50 EGP [discontinued] 4. ISOTRETINOIN [3rd line] Adult initially 0.2 mg/kg per day, tapering to 0.1 to 0.05 mg/kg per day Peds 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. 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. Caution 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" (