Perioral dermatitis in children – clinical presentation, pathogenesis-related factors and response to topical metronidazole

Background: Perioral dermatitis, a common skin disorder in young women, is rarely described in children. Objective: This study elaborates the clinical features of perioral dermatitis in children as well as possible pathogenetic mechanisms and the response to topical metronidazole. Methods: Seven children (4 females, 3 males between 4 and 12 years of age) were evaluated and dermatological examination was carried out. Pretreatment with topical corticosteroids was documented. Skin prick test with a panel of six common aeroallergens was performed in all children. All children were screened for gastrointestinal colonization with Candida albicans. Patients were treated with topical metronidazole 1% during the first 2 weeks. From the 3rd week on 2% metronidazole was used. Results: In all but one child topical corticosteroids had been used in the face prior to the first presentation at our outpatient department suggesting a possible pathogenetic role. An association with atopy or intestinal Candida colonization was not found. In all children skin lesions resolved after 3–6 months. The children remained free of symptoms over an observation period of 2 years. Conclusion: Perioral dermatitis has to be considered as differential diagnosis in children presenting with erythematous papules and papulovesicles in typical locations. Metronidazole proved to be effective and safe in the treatment of perioral dermatitis in children. Atopy and gastrointestinal colonization with C. albicans do not seem to play a role in the pathogenesis of perioral dermatitis.