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Gürtler A, Schmitt L. Der Einfluss der Ernährung bei entzündlichen Gesichtsdermatosen. J Dtsch Dermatol Ges 2022; 20:185-204. [PMID: 35146875 DOI: 10.1111/ddg.14683_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/05/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Anne Gürtler
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, LMU, München
| | - Laurenz Schmitt
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Aachen
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Gürtler A, Laurenz S. The impact of clinical nutrition on inflammatory skin diseases. J Dtsch Dermatol Ges 2022; 20:185-202. [PMID: 35088524 DOI: 10.1111/ddg.14683] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/05/2021] [Indexed: 12/11/2022]
Abstract
The influence of nutrition on the pathophysiology and clinical severity of inflammatory facial dermatoses such as acne, rosacea, seborrheic dermatitis, and perioral dermatitis has been controversially discussed for years. As part of a modern treatment approach, clinicians should provide patients with information on how their choice of diet might impact their dermatologic diagnosis and could potentially enhance therapeutic outcome. Recently, the concept of a gut-skin axis has gained momentum in the understanding of inflammatory dermatoses, with nutrition considered a contributing factor in this context. For example, gastrointestinal symptoms in rosacea patients may indicate a dysbiosis of the gut microbiome, treatment of which may also improve severity of the skin disease. New research efforts were recently made for acne patients addressing the clinical effects of omega-3 fatty acids and probiotics. In contrast, due to the limited data available, no comparable specific dietary recommendations can yet be made for seborrheic or perioral dermatitis. However, there are promising signs that clinical nutrition and dermatology will be more extensively interlinked in the future, both clinically and scientifically.
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Affiliation(s)
- Anne Gürtler
- Department for Dermatology and Allergy, University Hospital Munich, LMU, Munich, Germany
| | - Schmitt Laurenz
- Department of Dermatology and Allergology, University Hospital Aachen, Germany
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Gray NA, Tod B, Rohwer A, Fincham L, Visser WI, McCaul M. Pharmacological interventions for periorificial (perioral) dermatitis in children and adults: a systematic review. J Eur Acad Dermatol Venereol 2021; 36:380-390. [PMID: 34779023 DOI: 10.1111/jdv.17817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/03/2021] [Indexed: 11/30/2022]
Abstract
The plethora of pharmacologic treatments used for periorificial dermatitis (POD) makes clinical decision-making challenging. The objectives of this review were to assess the efficacy and safety of pharmacological interventions for POD in children and adults. The search was performed on 2 February 2021 and included seven databases and trial registries, with no date or language restrictions Study selection, data extraction and risk of bias assessments were performed independently and in duplicate by two authors, in accordance with a prespecified protocol. Meta-analyses were performed and reported in accordance with PRISMA guidelines. Where meta-analysis was not possible, a narrative synthesis was performed and reported in accordance with SWiM guidelines. The certainty of evidence was assessed using the Grading of Recommendation, Assessment, Development and Evaluation approach. Eleven studies representing 733 participants were included. Oral tetracycline may improve physician-reported severity of POD from day 20 onwards (low certainty evidence). Adverse effects may include abdominal discomfort, facial dryness and pruritus. Pimecrolimus cream may improve physician-reported severity slightly after 4 weeks of treatment (MD -0.49, 95% CI -1.02 to 0.04, n = 164, low certainty evidence). Adverse effects may include erythema, herpes simplex virus infection, burning and pruritus. Azelaic acid gel may result in no change in either physician- or patient-reported severity after 6 weeks of treatment. The evidence is very uncertain about the effect of praziquantel ointment on physician-reported severity and skin-related quality of life after 4 weeks of treatment. The evidence is also very uncertain about the effect of topical clindamycin/benzoyl peroxide on physician-reported severity. The body of evidence to inform treatment of POD currently consists of low and very low certainty evidence for important outcomes. Well-designed trials are needed to further investigate treatment options. Data are required for children and from low-middle income countries to improve external validity. Future trials should also include adequate post-treatment follow-up and standardized outcome measures.
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Affiliation(s)
- N A Gray
- Division of Dermatology, Department of Medicine, Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa
| | - B Tod
- Division of Dermatology, Department of Medicine, Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa
| | - A Rohwer
- Centre for Evidence Based Health Care (CEBHC), Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - L Fincham
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - W I Visser
- Division of Dermatology, Department of Medicine, Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa
| | - M McCaul
- Centre for Evidence Based Health Care (CEBHC), Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Kim BR, Kim M, Choi CW, Cho S, Youn SW. Predictive Model for Differential Diagnosis of Inflammatory Papular Dermatoses of the Face. Ann Dermatol 2020; 32:298-305. [PMID: 33911757 PMCID: PMC7992653 DOI: 10.5021/ad.2020.32.4.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/26/2020] [Accepted: 03/31/2020] [Indexed: 11/08/2022] Open
Abstract
Background The clinical features of inflammatory papular dermatoses of the face are very similar. Their clinical manifestations have been described on the basis of a small number of case reports and are not specific. Objective This study aimed to use computer-aided image analysis (CAIA) to compare the clinical features and parameters of inflammatory papular dermatoses of the face and to develop a formalized diagnostic algorithm based on the significant findings. Methods The study included clinicopathologically confirmed inflammatory papular dermatoses of the face: 8 cases of eosinophilic pustular folliculitis (EPF), 13 of granulomatous periorificial dermatitis-lupus miliaris disseminatus faciei (GPD-LMDF) complex, 41 of granulomatous rosacea-papulopustular rosacea complex (GR-PPR) complex, and 4 of folliculitis. Clinical features were evaluated, and area density of papular lesions was quantitatively measured with CAIA. Based on these variables, we developed a predictive model for differential diagnosis using classification and regression tree analysis. Results The EPF group showed lesion asymmetry and annular clusters of papules in all cases. The GPD-LMDF complex group had significantly higher periocular density. The GR-PPR complex group showed a higher area density of unilateral cheek papules and the highest total area density. According to the predictive model, 3 variables were used for differential diagnosis of the 4 disease groups, and each group was diagnosed with a predicted probability of 67%~100%. Conclusion We statistically confirmed the distinct clinical features of inflammatory papular dermatoses of the face and proposed a diagnostic algorithm for clinical diagnosis.
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Affiliation(s)
- Bo Ri Kim
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Minsu Kim
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chong Won Choi
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Soyun Cho
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea.,Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Woong Youn
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
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Srour J, Bengel J, Linden T, Jovanovic Z, Roggenkamp D, Reinholz M, Rothenberger C, Neufang G, Wollenberg A. Efficacy of a skin care cream with TRPV1 inhibitor 4‐t‐butylcyclohexanol in the topical therapy of perioral dermatitis. J Cosmet Dermatol 2019; 19:1409-1414. [DOI: 10.1111/jocd.13175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 09/13/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Jerome Srour
- Department of Dermatology and Allergy Ludwig‐Maximilian University Munich Germany
| | - Julia Bengel
- Department of Dermatology and Allergy Ludwig‐Maximilian University Munich Germany
| | - Teresa Linden
- Department of Dermatology and Allergy Ludwig‐Maximilian University Munich Germany
| | | | | | - Markus Reinholz
- Department of Dermatology and Allergy Ludwig‐Maximilian University Munich Germany
| | | | | | - Andreas Wollenberg
- Department of Dermatology and Allergy Ludwig‐Maximilian University Munich Germany
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Chiriac A, Diaconeasa A, Podoleanu C, Stolnicu S. Childhood Perioral Dermatitis — Challenging Treatment. JOURNAL OF INTERDISCIPLINARY MEDICINE 2018. [DOI: 10.1515/jim-2018-0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background: Also known as papulopustular dermatitis (chronic form), rosacea-like dermatitis, periorificial dermatitis, or airhostess’ dermatitis, perioral dermatitis is a commonly encountered dermatological disease, especially in adult women and less frequently in children. Its diagnosis and treatment are a challenge especially in small children.
Case report: We present the case of a 2-year-old girl referred to the dermatologist for widespread erythematous papules, vesicles, and pustules on the perioral area, nasolabial folds, and on the outer region of the lower eyelids. Several diagnoses had been established during the previous months: impetigo, atopic dermatitis, seborrheic dermatitis, allergic contact dermatitis, childhood rosacea, demodecidosis, infantile acne, and variable therapeutic approaches had been tried, with no clinical improvement. Clarithromycin 250 mg/day orally associated with the application of 2% erythromycin solution were successfully used.
Conclusion: This case highlights the importance of the clinical diagnosis of perioral dermatitis in young children, of excluding other diagnoses and worthless treatments, and also the chronic evolution of the disease and its individualized treatment.
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Affiliation(s)
- Anca Chiriac
- Nicolina Medical Center, Department of Dermatology , Iași , Romania
- Apollonia University , Iași , Romania
- P. Poni Research Institute, Romanian Academy , Iași , Romania
| | - Adriana Diaconeasa
- Dermatology Outpatient Care Center, “Grigore Alexandrescu” Clinical Emergency Hospital for Children , Bucharest , Romania
| | - Cristian Podoleanu
- Department of Internal Medicine , University of Medicine and Pharmacy , Tîrgu Mureș , Romania
| | - Simona Stolnicu
- Department of Pathology , University of Medicine and Pharmacy , Tîrgu Mureș , Romania
- Histopat Invest Laboratory , Tîrgu Mureş , Romania
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Yang CS, Teeple M, Muglia J, Robinson-Bostom L. Inflammatory and glandular skin disease in pregnancy. Clin Dermatol 2016; 34:335-43. [DOI: 10.1016/j.clindermatol.2016.02.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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8
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Abstract
Acne is the most common skin disease. Distinguishing between true acne vulgaris and the various acneiform eruptions is important yet sometimes challenging. Given the common nature of acne and acneiform eruptions, the pediatrician must be aware of these lesion patterns and possess the skills to effectively evaluate the pediatric presentation of these eruptions. This article discusses several of the most common acneiform eruptions, including neonatal acne and cephalic pustulosis, periorificial dermatitis (perioral dermatitis), facial angiofibromas, iatrogenic acneiform drug eruptions, and childhood rosacea.
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Abstract
Rosacea is a chronic inflammatory dermatosis characterized by outbreaks of exacerbation and remission. The diagnosis of rosacea based on specific clinical criteria, mainly centrofacial erythema occurring between 30 and 50 years. The disease predominates in women, in light phototype, especially from Northern Europe. Several classifications of the disease exist. In France, Edouard Grosshans described four stages. Stage I is that of flushing, stage II is that of erythrocouperosis, stage III papules and pustules and stage IV rhinophyma. German schools described only 3 stages, like experts from the National Rosacea Society (NRS), who described four subtypes: • 1. erythematotelangiectatic rosacea; • 2. papulopustular rosacea; • 3. phymas; • 4. ocular rosacea. The patient can enter the disease at any stage. CLINICAL ASPECTS OF ROSACEA: Stage I (flushes) sometimes starts very early at the age of 20 years by the occurrence of paroxysmal facial erythema that might be associated with conjunctival hyperemia. Flushes occur after meals, sudden change in temperature or absorption of alcohol or hot drinks. Stage II or erythrocouperosis comprises permanent facial erythema with telangiectasia. Stage III is the most characteric of the disease. On the erythematous background patient develop outbreak of papules and pustules. Stage IV is mainly observed in males and is characterized mainly by rhinophyma. There is no consensus regarding the description of the other variants. NRS describe a particular subtype, granulomatous or lupoid rosacea, characterized by yellowish or brownish papules of the cheeks and peri-orificial areas. Ocular rosacea is common and should be systematically looked for in all patients with rosacea. Steroid rosacea is a complication of topical corticosteroids use on the face. Fulminant rosacea occurs abruptly in young women, who develop papules, pustules and deep purulent sinuses. Treatment includes the combination of systemic corticosteroids and isotretinoin. Rosacea is also possible in children. Clinical knowledge of rosacea and its clinical forms is essential for appropriate treatment, that can change the patients'life.
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Affiliation(s)
- J-L Schmutz
- Département de dermatologie et allergologie, CHU Nancy - BSM, 6 rue du Morvan, 54500 Vandœuvre-Lès-Nancy, France.
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Mooney E, Rademaker M, Dailey R, Daniel BS, Drummond C, Fischer G, Foster R, Grills C, Halbert A, Hill S, King E, Leins E, Morgan V, Phillips RJ, Relic J, Rodrigues M, Scardamaglia L, Smith S, Su J, Wargon O, Orchard D. Adverse effects of topical corticosteroids in paediatric eczema: Australasian consensus statement. Australas J Dermatol 2015; 56:241-51. [DOI: 10.1111/ajd.12313] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 01/08/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Emma Mooney
- Department of Paediatric Dermatology; Royal Children's Hospital; Melbourne Victoria
| | - Marius Rademaker
- Department of Dermatology; Waikato Hospital; Hamilton New Zealand
| | | | - Ben S Daniel
- Department of Paediatric Dermatology; Royal Children's Hospital; Melbourne Victoria
| | - Catherine Drummond
- Department of Dermatology; Canberra Hospital; Canberra Australian Capital Territory
- Australian National University; Canberra Australian Capital Territory
| | - Gayle Fischer
- Department of Dermatology; Royal North Shore Hospital; Sydney New South Wales
- Sydney Medical School; University of Sydney; Sydney New South Wales
| | - Rachael Foster
- Department Paediatric Dermatology; Princess Margaret Hospital for Children; Perth Western Australia Australia
| | - Claire Grills
- Department of Paediatric Dermatology; Royal Children's Hospital; Melbourne Victoria
| | - Anne Halbert
- Department Paediatric Dermatology; Princess Margaret Hospital for Children; Perth Western Australia Australia
| | - Sarah Hill
- Department of Dermatology; Waikato Hospital; Hamilton New Zealand
| | - Emma King
- Department of Paediatric Dermatology; Royal Children's Hospital; Melbourne Victoria
| | - Elizabeth Leins
- Department of Paediatric Dermatology; Royal Children's Hospital; Melbourne Victoria
| | - Vanessa Morgan
- Department of Paediatric Dermatology; Royal Children's Hospital; Melbourne Victoria
- Department of Dermatology; Royal Melbourne Hospital; Melbourne Victoria
| | - Roderic J Phillips
- Department of Paediatrics; Monash University; Melbourne Victoria
- Department of Vascular Biology; Royal Children's Hospital; Melbourne Victoria
- Murdoch Children's Research Institute; Melbourne Victoria
| | - John Relic
- Department of Dermatology; Royal Newcastle Centre; Newcastle New South Wales
| | - Michelle Rodrigues
- Department of Paediatric Dermatology; Royal Children's Hospital; Melbourne Victoria
- Department of Dermatology; St Vincent's Hospital; Melbourne Victoria
| | - Laura Scardamaglia
- Department of Paediatric Dermatology; Royal Children's Hospital; Melbourne Victoria
- University of Melbourne; Melbourne Victoria
- Department of Dermatology; Royal Melbourne Hospital; Melbourne Victoria
- Department of Dermatology; Western Hospital; Melbourne Victoria
| | - Saxon Smith
- Department of Dermatology; Royal North Shore Hospital; Sydney New South Wales
- Sydney Medical School; University of Sydney; Sydney New South Wales
| | - John Su
- Department of Paediatric Dermatology; Royal Children's Hospital; Melbourne Victoria
- University of Melbourne; Melbourne Victoria
- Department of Dermatology, Eastern Health; Murdoch Children's Research Institute; Melbourne Victoria
- Monash University; Melbourne Victoria
- Murdoch Children's Research Institute; Melbourne Victoria
| | - Orli Wargon
- Department Paediatric Dermatology; Sydney Children's Hospital; Sydney New South Wales
| | - David Orchard
- Department of Paediatric Dermatology; Royal Children's Hospital; Melbourne Victoria
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Wagner G, Rose C, Sachse MM. [Childhood granulomatous periorificial dermatitis]. Hautarzt 2014; 65:903-7. [PMID: 25115983 DOI: 10.1007/s00105-014-2831-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
CASE REPORT A 14-year-old patient of African ancestry presented with multiple papules in the perioral, perinasal and periocular areas. Histopathology showed sarcoidal granulomas. DIAGNOSIS After exclusion of systemic sarcoidosis, the diagnosis of childhood granulomatous periorificial dermatitis was made. THERAPY Topical treatment with erythromycin resulted in complete regression. CONCLUSION Childhood granulomatous periorificial dermatitis is mainly observed in dark-skinned children of African, Caribbean, or Asian origin. The nosological position of the dermatosis is controversial. Originally classified as sarcoidosis, childhood granulomatous periorificial dermatitis is now generally regarded as a special form of perioral dermatitis.
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Affiliation(s)
- G Wagner
- Klinik für Dermatologie, Allergologie und Phlebologie, Klinikum Bremerhaven Reinkenheide, Postbrookstr. 103, 27574, Bremerhaven, Deutschland,
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Ehmann L, Reinholz M, Maier T, Lang M, Wollenberg A. Efficacy and Safety Results of a Drug-Free Cosmetic Fluid for Perioral Dermatitis: The Toleriane Fluide Efficacy in Perioral Dermatitis (TOLPOD) Study. Ann Dermatol 2014; 26:462-8. [PMID: 25143674 PMCID: PMC4135100 DOI: 10.5021/ad.2014.26.4.462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 08/11/2013] [Accepted: 09/03/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Perioral dermatitis (POD) is a common inflammatory skin disease without standard therapy. OBJECTIVE We sought to evaluate the clinical value of a soothing fluid for the treatment of POD. METHODS We included 51 patients with POD in this 8-week clinical trial. The Toleriane Fluide Efficacy in Perioral Dermatitis (TOLPOD) study had an open-label design and involved twice-daily application of Toleriane Fluide, a soothing cosmetic fluid. Clinical assessment of POD was performed with a predefined questionnaire including the POD severity index (PODSI). Control visits were made after 4 and 8 weeks of treatment. RESULTS The results were compared with those of a historical control group treated with a vehicle cream. Patients treated with the soothing fluid showed a continuous and significant improvement of the PODSI over time. The improvement of PODSI observed with the soothing fluid was better, but not significantly better, than that observed in the historical controls. In addition, the subjective complaints of patients such as disease burden, itching, distension of the skin, and appearance improved during treatment. CONCLUSION A soothing fluid could be a clinically useful treatment option for POD.
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Affiliation(s)
- Laura Ehmann
- Department of Dermatology and Allergy, Ludwig Maximilian University, Munich, Germany. ; Department of Dermatology, Heinrich Heine University, Dusseldorf, Germany
| | - Markus Reinholz
- Department of Dermatology and Allergy, Ludwig Maximilian University, Munich, Germany
| | - Tanja Maier
- Department of Dermatology and Allergy, Ludwig Maximilian University, Munich, Germany
| | - Martin Lang
- Department of Dermatology and Allergy, Ludwig Maximilian University, Munich, Germany
| | - Andreas Wollenberg
- Department of Dermatology and Allergy, Ludwig Maximilian University, Munich, Germany
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Bribeche MR, Fedotov VP, Jillella A, Gladichev VV, Pukhalskaya DM. Topical praziquantel as a new treatment for perioral dermatitis: results of a randomized vehicle-controlled pilot study. Clin Exp Dermatol 2014; 39:448-53. [DOI: 10.1111/ced.12342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2014] [Indexed: 01/03/2023]
Affiliation(s)
- M. R. Bribeche
- Department of Dermatology and Venereology; Zaparozhye Medical State University; Zaparozhye Ukraine
| | - V. P. Fedotov
- Department of Dermatology and Venereology; Zaparozhye Medical State University; Zaparozhye Ukraine
| | - A. Jillella
- Department of Dermatology and Venereology; Zaparozhye Medical State University; Zaparozhye Ukraine
| | - V. V. Gladichev
- Department of Drug Chemistry and Technologies; Zaporozhye Medical State University; Zaporozhye Ukraine
| | - D. M. Pukhalskaya
- Department of Drug Chemistry and Technologies; Zaporozhye Medical State University; Zaporozhye Ukraine
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Abstract
When assessing a patient with a new dermatologic condition, developing a differential diagnosis is essential to ensure the condition is not elusive as a workup and potential therapy are considered. Subsequent narrowing of that differential based on history and physical examination can allow a more targeted approach to diagnostic testing and triage, and hasten an effective treatment and resolution. The authors hope to have provided useful historical and clinical clues to aid in the rapid differentiation of the more common diagnoses for alopecias and rashes of the face, intertriginous areas, and legs.
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Affiliation(s)
- Jay C Vary
- Division of Dermatology, Department of Internal Medicine, The University of Washington, Box 354697, 4225 Roosevelt Way Northeast, 4th Floor, Seattle, WA 98195, USA.
| | - Kim M O'Connor
- Division of General Internal Medicine, Department of Internal Medicine, Box 354760, 4245 Roosevelt Way Northeast, Seattle, WA 98195, USA
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Tempark T, Shwayder TA. Perioral dermatitis: a review of the condition with special attention to treatment options. Am J Clin Dermatol 2014; 15:101-13. [PMID: 24623018 DOI: 10.1007/s40257-014-0067-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Perioral dermatitis is a common acneiform facial eruption found in both adults and children. Its variants are periorificial and granulomatous periorificial dermatitis. The etiology of perioral dermatitis remains unknown; however, topical corticosteroid use on the face commonly precedes the manifestation of this condition. There are an overwhelming number of treatment options for perioral dermatitis, and the options in children are slightly different from those in adults for both systemic medications and topical treatment. This article provides a literature review of the various applicable treatments available based on the level and quality of the evidence by the US Preventive Service Task Force. Oral tetracycline reveals the best valid evidence. However, if the patient is less than 8 years old, then this oral therapy may not be suitable. Topical metronidazole, erythromycin, and pimecrolimus also represent effective treatment choices with good evidence. Topical corticosteroid use is common in these cases and the question of whether it is a good treatment or a cause remains unanswered. Corticosteroid cream can improve the clinical picture, but there is a risk of rebound when treatment is stopped. We propose a treatment algorithm to assist dermatologists, pediatric dermatologists, and general practitioners encountering this condition.
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Caputo R, Barbareschi M. Current and future treatment options for perioral dermatitis. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17469872.2.3.351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bhat RM, Chavda R, Ribet V. To evaluate the efficacy and safety of "RV2427B" cream in Irritant dermatitis care. Indian Dermatol Online J 2013; 4:180-4. [PMID: 23984228 PMCID: PMC3752470 DOI: 10.4103/2229-5178.115511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: The treatment of various irritant dermatitis involves the elimination of the casual or favoring factor, the control of aggravating factors, and administration of topical agents. Even though corticosteroids are extensively used in these conditions to reduce the inflammation, it can also result in undesirable side effects. Hence, there is a need for a non steroidal topical agent to be used in these conditions. Aims: To evaluate the efficacy and tolerance of repairing cream RV 2427B in children and adults in irritant dermatitis care. Materials and Methods: In this phase III open labeled, multicenter, non-controlled, non-randomized trial, irritant dermatitis in children and adults either due to diaper rash, pityriasis alba and irritant dermatitis (eczema), perioral dermatitis, perleche or intertrigo were administered; repairing cream RV 2427 B containing a) 4 % zinc oxide, b) 2.5 % dry colloidal oat extract, (c) 0.5 % oat oil, (d) 0.2% copper sulfate, and (e) 0.1 % zinc sulfate to be applied twice-daily in the affected area. The subjects were evaluated on day 7 and day 21 for both efficacy and tolerance and last visit for cosmetic acceptability. The trial was conducted in accordance with the good clinical practices (GCP) after obtaining ethical clearance from respective Institutional Review Boards. Statistical evaluation was by variance analysis and student test for the quantitative variables, chi-square test for the qualitative variables. Results: Of the 136 enrolled subjects, 95 completed the study. After 21 days of treatment, 84% of the subjects assessed by the investigator and 76% by the self-assessment for the cream found effective. Investigational product was considered to be safe after 7 and 21 days of use. Conclusion: Repairing cream RV 2427 B is effective and safe in the management of irritant dermatitis.
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Affiliation(s)
- Ramesh M Bhat
- Department of Dermatology, Fr Muller Medical College, Mangalore, India
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Teraki Y, Hitomi K, Sato Y, Izaki S. Tacrolimus-induced rosacea-like dermatitis: a clinical analysis of 16 cases associated with tacrolimus ointment application. Dermatology 2012; 224:309-14. [PMID: 22626964 DOI: 10.1159/000338693] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 04/10/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Recently, reports have indicated that the continuous use of topical calcineurin inhibitors such as tacrolimus may induce rosacea-like dermatitis (RD). OBJECTIVE AND METHODS To assess clinical features of RD associated with tacrolimus, 44 cases of patients diagnosed with RD between 2005 and 2010 at our hospital were retrospectively reviewed. RESULTS In total, 22 cases were caused by topical steroid use, 8 by topical tacrolimus use, and 8 by consecutive treatment with topical steroids and tacrolimus. Clinical presentation was basically similar among the 3 groups, although the nose was less frequently affected and pustules were rarely observed in the latter 2 sets of cases. Demodex mites were often found in smears of skin lesions from patients with RD caused by steroids and tacrolimus. Treatment with topical metronidazole was effective in most RD patients. CONCLUSION Topical tacrolimus is becoming an important cause of RD along with topical steroids.
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Affiliation(s)
- Yuichi Teraki
- Department of Dermatology, Saitama Medical University, Saitama Medical Center, Saitama, Japan. teraki @ saitama-med.ac.jp
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Mullan E, Green P, Pasternak S. Lupus Miliaris Disseminatus Faciei with Extrafacial Involvement in a 17-Year-Old White Girl. J Cutan Med Surg 2011; 15:340-3. [DOI: 10.2310/7750.2011.10034] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Lupus miliaris disseminatus faciei (LMDF) is a benign condition characterized by a papular eruption located in the central face. Histologic studies of the papules show granulomatous infiltrates with central necrosis. The condition is self-limited and usually resolves within 1 to 2 years yet can be cosmetically debilitating, given the location and potential for scarring. Granulomatous periorificial dermatitis similarly affects the face with granulomatous lesions and may overlap clinically with LMDF. Conclusion: This report highlights the challenge in differentiating and treating uncommon granulomatous facial dermatoses.
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Affiliation(s)
- Erin Mullan
- From the Department of Dermatology, McGill University Health Centre, Montreal, QC; Division of Dermatology, Department of Medicine, and Division of Anatomical Pathology, Department of Pathology and Laboratory Medicine, Dalhousie University and Queen Elizabeth Health Sciences Centre, Halifax, NS
| | - Peter Green
- From the Department of Dermatology, McGill University Health Centre, Montreal, QC; Division of Dermatology, Department of Medicine, and Division of Anatomical Pathology, Department of Pathology and Laboratory Medicine, Dalhousie University and Queen Elizabeth Health Sciences Centre, Halifax, NS
| | - Sylvia Pasternak
- From the Department of Dermatology, McGill University Health Centre, Montreal, QC; Division of Dermatology, Department of Medicine, and Division of Anatomical Pathology, Department of Pathology and Laboratory Medicine, Dalhousie University and Queen Elizabeth Health Sciences Centre, Halifax, NS
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Kim YJ, Shin JW, Lee JS, Park YL, Whang KU, Lee SY. Childhood granulomatous periorificial dermatitis. Ann Dermatol 2011; 23:386-8. [PMID: 21909215 PMCID: PMC3162274 DOI: 10.5021/ad.2011.23.3.386] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 07/26/2010] [Accepted: 07/26/2010] [Indexed: 11/08/2022] Open
Abstract
Childhood granulomatous periorificial dermatitis (CGPD), also known as facial Afro-Caribbean childhood eruption (FACE), is a distinctive granulomatous form of perioral dermatitis. It is a condition of unknown etiology, characterized by monomorphous, small, papular eruptions around the mouth, nose and eyes that histopathologically show a granulomatous pattern. It affects prepubescent children of both sexes and typically persists for several months but resolved without scarring. We report a 9 year-old girl with multiple, discrete, monomorphic, papular eruptions of 2-months duration on the perioral and periocular areas. Histopathological examination demonstrated upper dermal and perifollicular granulomatous infiltrate.
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Affiliation(s)
- Yoon Jee Kim
- Department of Dermatology, College of Medicine, Soonchunhyang University, Cheonan, Korea
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22
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Abstract
Patients with rosacea frequently present with coexisting skin conditions, such as seborrheic dermatitis, acne, perioral dermatitis, and melasma, which may complicate diagnosis and treatment. This article discusses the presentation, pathophysiology, and management of rosacea with common concomitant skin disorders.
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Wollenberg A, Bieber T, Dirschka T, Luger T, Meurer M, Proksch E, Schön MP, Schwarz T, Thaçi D, Zuberbier T, Werfel T. Perioral dermatitis. J Dtsch Dermatol Ges 2010; 9:422-7. [PMID: 21040469 DOI: 10.1111/j.1610-0387.2010.07329.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Andreas Wollenberg
- Department of Dermatology and Allergy, Ludwig Maximilian University of Munich, Frauenlobstr. 9–11, D-80337 Munich, Germany.
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Schwarz T, Kreiselmaier I, Bieber T, Thaci D, Simon JC, Meurer M, Werfel T, Zuberbier T, Luger TA, Wollenberg A, Bräutigam M. A randomized, double-blind, vehicle-controlled study of 1% pimecrolimus cream in adult patients with perioral dermatitis. J Am Acad Dermatol 2008; 59:34-40. [DOI: 10.1016/j.jaad.2008.03.043] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Revised: 02/15/2008] [Accepted: 03/25/2008] [Indexed: 10/22/2022]
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Oppel T, Pavicic T, Kamann S, Bräutigam M, Wollenberg A. Pimecrolimus cream (1%) efficacy in perioral dermatitis ? results of a randomized, double-blind, vehicle-controlled study in 40 patients. J Eur Acad Dermatol Venereol 2007; 21:1175-80. [PMID: 17894701 DOI: 10.1111/j.1468-3083.2007.02191.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Perioral dermatitis (POD) is a common skin disease and difficult to treat. Pimecrolimus cream (1%) successfully controls atopic eczema. OBJECTIVE Our aim was to investigate its efficacy in POD. STUDY DESIGN Single-centre, randomized, double-blind, vehicle-controlled study including 40 POD patients with a 4-week treatment and a 4-week follow-up. Efficacy was assessed by a novel Perioral Dermatitis Severity Index (PODSI) and Finlay's Dermatology Life Quality Index (DLQI). SETTING Outpatient clinics of a large dermatological hospital in Munich, Germany. RESULTS During treatment, the PODSI was significantly lower in the pimecrolimus group compared with vehicle (P = 0.005-0.02) whereas at follow-up, no significant differences were observed. At week 2, the responder rates (> or = 50% PODSI improvement) were 50% with pimecrolimus cream (1%) and 25% with vehicle (P = 0.095). DLQI was improved in pimecrolimus group compared with vehicle. CONCLUSION Results suggest that pimecrolimus cream (1%) effectively treats acute-stage POD.
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Affiliation(s)
- T Oppel
- Department of Dermatology and Allergy, Ludwig-Maximilians University, Munich, Germany
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27
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Rodríguez-Martín M, Sáez-Rodríguez M, Carnerero-Rodríguez A, Rodríguez-García F, Cabrera de Paz R, Sidro-Sarto M, Guimerá F, Sánchez R, García-Bustínduy M, Noda-Cabrera A. Treatment of perioral dermatitis with topical pimecrolimus. J Am Acad Dermatol 2007; 56:529-30. [PMID: 17317501 DOI: 10.1016/j.jaad.2005.03.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2005] [Revised: 03/04/2005] [Accepted: 03/07/2005] [Indexed: 11/19/2022]
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Goss JM, Nord KM, Olarte MR, Grossman ME. Perioral dermatitis in a patient with myasthenia gravis following systemic corticosteroid treatment. Br J Dermatol 2007; 156:582. [PMID: 17300257 DOI: 10.1111/j.1365-2133.2006.07668.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hengge UR, Ruzicka T, Schwartz RA, Cork MJ. Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol 2006; 54:1-15; quiz 16-8. [PMID: 16384751 DOI: 10.1016/j.jaad.2005.01.010] [Citation(s) in RCA: 594] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2004] [Revised: 12/03/2004] [Accepted: 01/03/2005] [Indexed: 02/08/2023]
Abstract
UNLABELLED Topical corticosteroids were introduced into medicine about 50 years ago. They represent a significant milestone in dermatologic therapy. Despite encouragement to report observed adverse drug reactions, the clinical practice of reporting is poor and incomplete. Likewise, adverse effects and safety of topical corticosteroids are neglected in the medical literature. The authors provide an updated review of their adverse-effect profile. Children are more prone to the development of systemic reactions to topically applied medication because of their higher ratio of total body surface area to body weight. Cutaneous adverse effects occur regularly with prolonged treatment and are dependent on the chemical nature of the drug, the vehicle, and the location of its application. The most frequent adverse effects include atrophy, striae, rosacea, perioral dermatitis, acne, and purpura. Those that occur with lower frequency include hypertrichosis, pigmentation alterations, delayed wound healing, and exacerbation of skin infections. Of particular interest is the rate of contact sensitization against corticosteroids, which is considerably higher than generally believed. Systemic reactions such as hyperglycemia, glaucoma, and adrenal insufficiency have also been reported to follow topical application. The authors provide an updated review of local and systemic adverse effects upon administration of topical corticosteroids, including the latest FDA report on the safety of such steroids in children. LEARNING OBJECTIVE At the completion of this learning activity, participants should be familiar with topical corticosteroids and their proper use.
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Affiliation(s)
- Ulrich R Hengge
- Department of Dermatology, Heinrich-Heine University Duesseldorf, Germany.
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Misago N, Nakafusa J, Narisawa Y. Childhood granulomatous periorificial dermatitis: lupus miliaris disseminatus faciei in children? J Eur Acad Dermatol Venereol 2005; 19:470-3. [PMID: 15987296 DOI: 10.1111/j.1468-3083.2004.01178.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Childhood granulomatous periorificial dermatitis (CGPD) is a granulomatous disease characterized by monomorphous, small papular eruptions around the mouse, nose and eyes, and is thought to be closely related to perioral dermatitis. This condition has always been believed to occur more commonly in dark-skinned patients; however, recent observations have revealed CGPD to occur also in white patients. OBSERVATION We report an 11-year-old Japanese boy with the characteristic features of CGPD. Although sarcoidosis and acne/granulomatous rosacea could be differentiated from CGPD, we could find no essential differences between CGPD and lupus miliaris disseminatus faciei (LMDF). The cases of LMDF in children, which were recorded in the Japanese literature, had highly similar clinicopathological features to those of CGPD. This case responded dramatically to topical tacrolimus in combination with the oral administration of minocycline. CONCLUSIONS The entity 'facial idiopathic granulomas with regressive evolution' is considered to include LMDF (a common adult form), CGPD (a rare childhood form) and perioral dermatitis (a peculiar form exacerbated by topical corticosteroids). Topical tacrolimus may be recommended as one of the therapies for LMDF as well as CGPD.
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MESH Headings
- Administration, Cutaneous
- Administration, Oral
- Anti-Bacterial Agents/administration & dosage
- Child
- Dermatitis, Perioral/diagnosis
- Dermatitis, Perioral/drug therapy
- Dermatitis, Perioral/pathology
- Diagnosis, Differential
- Drug Therapy, Combination
- Granulomatous Disease, Chronic/diagnosis
- Granulomatous Disease, Chronic/drug therapy
- Granulomatous Disease, Chronic/pathology
- Humans
- Immunosuppressive Agents/administration & dosage
- Lupus Vulgaris/diagnosis
- Lupus Vulgaris/drug therapy
- Lupus Vulgaris/pathology
- Male
- Minocycline/administration & dosage
- Tacrolimus/administration & dosage
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Affiliation(s)
- N Misago
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga 849-8501, Japan.
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Sehgal VN, Srivastava G, Aggarwal AK, Belum VR, Reddy V, Sharma S. Lupus miliaris disseminatus faciei. Part I: Significance of histopathologic undertones in diagnosis. Skinmed 2005; 4:151-6. [PMID: 15891251 DOI: 10.1111/j.1540-9740.2005.03510.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Since its clinical discovery, lupus miliaris disseminatus faciei has sporadically been reported to have different modes of clinicopathologic expression. OBJECTIVE The purpose of this study was to work up a list of histopathologic undertones and to project and propagate lupus miliaris disseminatus faciei as an exclusive entity. An upcoming Part II of this study will present an overview of the disease. METHODS All patients visiting the outpatient clinic conforming to hitherto accepted clinical features were included to study patients' age and sex, duration of the disease, and above all, conduct a detailed histopathology review. Using the detailed information obtained, an endeavor was made to organize the disease into early, fully developed, and late lesions. RESULTS The details of the various parameters were of great help in evolving this modus operandi. The clinical as well as histopathologic features of lupus miliaris disseminatus faciei are fairly distinct and facilitate visualizing the entity as a spectrum comprising early, fully developed, and late lesions. Further studies are called for.
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Affiliation(s)
- Virendra N Sehgal
- Dermato-Venereology Centre, Sehgal Nursing Home, Panchwati, Azadpur, Delhi, India.
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Weber K, Thurmayr R. Critical Appraisal of Reports on the Treatment of Perioral Dermatitis. Dermatology 2005; 210:300-7. [PMID: 15942216 DOI: 10.1159/000084754] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2004] [Accepted: 11/05/2004] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Presently, problems exist with the rationale of oral therapy and the nature and indication of topical and accompanying treatment of perioral dermatitis. OBJECTIVE Providing the basis to overcome these problems by a quality evaluation of treatment reports and assessment of the consistency of treatment experience. METHODS Sources were Medline (1964-2004), Embase (1966-2004), the Cochrane Central (1971-2004) and 526 references of 3 textbooks, 2 recent reviews and 30 papers on perioral dermatitis. Thirty English and German articles were selected. These studies were evaluated according to principles of evidence-based medicine and related criteria. Evaluation of 28 papers was carried out by the authors and of our own 2 papers by 2 other reviewers. Consistency of results was qualitatively assessed by the authors. RESULTS There were only 2 therapeutic trials of medium-range quality. The other studies were of low quality. Consistency was noted concerning treatment with oral tetracycline (with 1 exception), discontinuation of topical corticosteroids and cosmetics and, to a lesser extent, regarding no therapy. There was inconsistency in respect to topical therapy. CONCLUSION The presented data help to interpret and conduct studies on the treatment of perioral dermatitis.
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Affiliation(s)
- Klaus Weber
- Krankenhaus der Missionsbenediktiner, Tutzing, Germany.
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Zalaudek I, Di Stefani A, Ferrara G, Argenziano G. Childhood granulomatous periorificial dermatitis: a controversial disease. Granulomatose periorifizielle Dermatitis der Kindheit: eine umstrittene Entitat. J Dtsch Dermatol Ges 2005; 3:252-5. [PMID: 16370472 DOI: 10.1111/j.1610-0387.2005.05009.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The etiology, diagnosis and treatment of childhood granulomatous periorificial dermatitis (GPD) are highly controversial. Some authors underline the similarities between GPD and perioral dermatitis and consider both as part of a spectrum while other authors regard GPD as a distinctive condition. Clinically GPD is a papulo-pustular periorificial disease of the face which histopathologically shows a granulomatous perifollicular infiltrate. Because of its granulomatous pattern, GPD also has been related to cutaneous sarcoidosis. The clinical course is benign and self-limited. Topical steroids are regarded as either the main cause or a worsening factor. While topical treatment is occasionally effective, systemic antibiotic therapy of GPD is usually recommended. We report a "typical" case of GPD and review the literature to discuss the difficulties in its diagnosis and treatment.
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Affiliation(s)
- Iris Zalaudek
- Department of Dermatology, Medical University of Graz, Austria.
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Dirschka T, Tronnier H, Fölster-Holst R. Epithelial barrier function and atopic diathesis in rosacea and perioral dermatitis. Br J Dermatol 2004; 150:1136-41. [PMID: 15214900 DOI: 10.1111/j.1365-2133.2004.05985.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Rosacea and perioral dermatitis (PD) are common dermatoses, the aetiology and pathogenesis of which remain speculative. Objectives To investigate skin barrier function and features of atopy in both diseases. METHODS We studied 75 patients with rosacea and 75 with PD. Transepidermal water loss (TEWL) was measured in three regions of the face (lateral chin, perinasal cheek, side of the nose) and the patients were assessed for atopy by clinical criteria, prick tests and specific IgE against a mixture of aeroallergens (CAP SX1). The control group consisted of 125 individuals with no history of rosacea, PD or active atopic disease. RESULTS In patients with PD, TEWL was significantly increased (P < 0.001) at all measurement points in comparison with the rosacea and control groups. Significantly (P < 0.001) higher values were also found regarding history and clinical signs of an atopic diathesis, prick test reactivity and specific IgE against aeroallergens. CONCLUSIONS PD is characterized by a skin barrier disorder of facial skin. It differs from rosacea in that it involves a significantly increased TEWL and features of an atopic diathesis. However, it remains disputed as to whether PD is an individual skin disease or a subtype of rosacea in atopic patients.
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Affiliation(s)
- T Dirschka
- Dermatological Practice Centre, Wuppertal, Germany.
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Abstract
BACKGROUND Perioral dermatitis paradoxically sometimes spares the entire perioral region. There may be isolated periocular involvement (periocular dermatitis). PATIENTS/METHODS The records of 23 patients with only periocular dermatitis were reviewed with respect to the following parameters: clinical findings, history of atopy, topical facial treatment, prick and patch tests, CAP-SX1, previous treatment, time to healing and relapses. 23 patients with no history of periocular dermatitis were matched for age and sex (case-control study). RESULTS The predominant clinical finding in the affected group was micropapules primarily in the lateral corner of the eye and lower eyelid. The groups differed significantly (p < 0.05) with regard to the history of atopic diseases and reactive prick tests. 22 patients regularly used face-care or eye-care products. These patients did not differ significantly from the control group with regard to frequency and type of product used. 6 patients had been previously treated with topical corticosteroids. The time to healing was 2-8 weeks (median: 4 weeks). CONCLUSIONS Periocular dermatitis is a variation on perioral dermatitis, where-by similar pathogenetic factors are observed. The elimination of topical corticosteroids and the gradual reduction of skin-care products regularly lead to clearing of the condition.
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Affiliation(s)
- Thomas Dirschka
- Institut für experimentelle Dermatologie der Universität Witten/Herdecke.
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