Ocular rosacea: an under-recognized entity

While rosacea is a common dermatologic condition, ocular rosacea is sometimes evident either with cutaneous rosacea or occasionally by itself. Manifesting with such varied symptoms as dry eye, Meibomian gland dysfunction, and corneal erosion, ocular rosacea can be confused with a multitude of other diseases. While ocular rosacea is commonly mild and rarely severe, physicians should still expand their examination to include ocular manifestations of rosacea. In addition, we propose diagnostic criteria for ocular rosacea, stressing the importance of early recognition and treatment.

Pediatric periorificial dermatitis: clinical course and treatment outcomes in 222 patients

BACKGROUND

Periorificial dermatitis (POD) is a rosacea-like papulopustular facial eruption most commonly reported in young adult women. Although POD has been reported in children as young as 6 months of age, there are limited data on the diagnosis and management of POD in pediatric cases.

METHODS

All children diagnosed with POD at the Dermatology Clinic at the University of North Carolina at Chapel Hill between June 2002 and March 2014 were included in the current study. Information related to demographics, associated risk factors, treatment prescribed, adverse effects, and response to treatment were obtained from a retrospective analysis of medical records.

RESULTS

Of the 222 children identified, 55.4% were female, 62.2% Caucasian, and the average age at presentation to the clinic was 6.6 years. Although the etiology of POD remains uncertain, 29.3% reported a past medical history of atopic dermatitis, 14.9% reported a history of asthma and 58.1% reported a history of steroid use prior to POD onset. Fifty-nine percent were seen at a clinic visit for follow-up at an average of 3.8 months. Treatment often involved combining oral azithromycin with topical metronidazole or sodium sulfacetamide lotion. Of the patients with documented follow-up, 71.8% experienced complete resolution of POD. Recurrence of POD occurred in children dependent on inhaled steroids or nebulizers. Adverse effects were minimally noted, but included pigmentary changes (1.8%), worsening of symptoms (1.8%), gastrointestinal upset (0.9%), irritant dermatitis (0.9%), and xerosis (0.5%).

CONCLUSION

This study discusses the clinical diagnosis and management of POD in pediatric cases.

Perioral dermatitis: a review of the condition with special attention to treatment options

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.

Periorificial dermatitis due to systemic corticosteroids in children: report of two cases

Periorificial dermatitis is a common acneiform eruption that is thought to represent a variant of rosacea. These patients typically present with uniform erythematous papules most commonly located periorally but also occurring around the nose and eyelids. This eruption has been linked to topical corticosteroid use, with only a few reports in the literature associated with systemic steroid use in adults. Here, we report two cases of periorificial dermatitis occurring after systemic corticosteroid use in children.