Pediatric periorificial dermatitis.

Periorificial dermatitis (POD) has been documented in the pediatric population in patients as young as 3 months, with a slight predominance in girls compared to boys. Many patients have a personal or family history of atopic disorders. Periorificial dermatitis typically presents with erythematous to flesh-colored papules and rarely pustules near the eyes, nose, and mouth. Although the etiology is unknown, many patients have had recent exposure to a topical or less commonly an inhaled or systemic corticosteroid. Although steroids may initially control the skin lesions, disease often rebounds after discontinuing therapy. Diagnosis of POD is clinical. Laboratory tests are not helpful in making the diagnosis, and the histology of POD resembles rosacea. It is important to rule out other acneform diagnoses based on the age of the patient, clinical history, and presentation of the lesions. Topical metronidazole has been successful in the pediatric population. For pediatric patients with extrafacial skin lesions or more severe disease, oral antibiotics such as tetracycline, doxycycline, minocycline, azithromycin, and erythromycin can be used, depending on the age of the patient.