Childhood granulomatous periorificial dermatitis: lupus miliaris disseminatus faciei in children?

Treatment of pediatric periorificial dermatitis with topical calcineurin inhibitor and topical/oral metronidazole

Pediatric periorificial dermatitis is a papulopustular eruption found around the facial orifices in children. Although the treatment of the disease has been largely anecdotal and experience-based, studies have shown that topical calcineurin inhibitors, as well as other topical and oral antibiotics, such as metronidazole, can be effective treatment options. However, most of the studies with a sizable number of patients have been based on the Caucasian population. Herein, we evaluated the clinical efficacy of topical calcineurin inhibitors and topical/oral metronidazole in 24 Korean patients with pediatric periorificial dermatitis. The majority of the patients showed a complete response to treatment.

Granulomatous Periorificial Dermatitis in an Adult: A case report with review of literature

Granulomatous periorificial dermatitis (GPD) is a benign, self-limiting eruption that is considered a clinical variant of periorificial dermatitis, also known as perioral dermatitis. It presents primarily in prepubertal children as monomorphic scaly papules over perioral, paranasal and periorbital areas of the face with rare occurrence in adults. We report a 36-year-old Omani male patient who presented to the Dermatology Clinic at Bahla Polyclinic, Bahla, Oman, in 2018 with a papular eruption over his face for the previous six months. Based on clinical and histopathological findings the patient was diagnosed with GPD with sarcoid-like histology. He was treated effectively with oral doxycycline and topical metronidazole. This report provides a review of the literature on GPD and summarises all reported cases in adults to date.

Topical calcineurin inhibitors for pediatric periorificial dermatitis

BACKGROUND

Data regarding the treatment of periorificial dermatitis with topical calcineurin inhibitors (TCI) in the pediatric population are limited.

OBJECTIVE

To assess the clinical utility of TCI in pediatric patients with periorificial dermatitis.

METHODS

A retrospective medical record review of all pediatric patients with periorificial dermatitis treated with TCIs was performed. Follow-up via telephone was performed to capture missing data.

RESULTS

A total of 132 patients met the inclusion criteria. The median age at diagnosis was 4.2 years (interquartile range, 2.3-8.2). The median follow-up was 5.2 months (interquartile range, 2.1-11.7). Seventy-two patients had evaluable follow-up data. Of these, 48 (67%) patients were treated with TCI alone, 12 (16.7%) were treated with a combination of TCI and topical metronidazole, and 9 (12.5%) were treated with a combination of TCI and a systemic antibiotic. Complete response was noted in 68.8% of patients treated with TCI alone, in 75% of patients treated with TCI and metronidazole, and in 77.8% of patients treated with TCI and a systemic antibiotic. Adverse events were rare and mild in severity.

CONCLUSION

Topical calcineurin inhibitors are an effective therapeutic option for pediatric patients with periorificial dermatitis and were well tolerated in this cohort.

Lupus miliaris disseminatus faciei in a young male

We report a case of a healthy 26-year-old male with multiple asymptomatic reddish papules and papule-nodules on the central area of the face, persisting from more than 2 months and gradually increasing in number. An incisional skin biopsy revealed a confluent dense granulomatous infiltrate centred by large areas of eosinophilic necrosis consistent with the diagnosis of lupus miliaris disseminatus faciei (LMDF). This is a rare dermatosis first described in 1878 by Fox, that often poses a clinical challenge as it is a disease process which is difficult to diagnose. In fact, in our case, a diagnosis of LMDF was made on skin biopsy. We think that collaboration among dermatologists and General Practitioners is very important for diagnosis of rare dermatosis and especially for management of it, in order to prevent the development of depressed scars.

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.

Lupus Miliaris Disseminatus Faciei with Extrafacial Involvement in a 17-Year-Old White Girl

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.

Granulomatous periorificial dermatitis: a variant of granulomatous rosacea in children?

BACKGROUND

We report a case of granulomatous periorificial dermatitis (GPD). A 13-year-old Jamaican boy presented with pink to flesh-colored perioral and periocular papules that erupted during a summer visit to Jamaica. The child was initially diagnosed with sarcoidosis and treated with oral corticosteroids, but the eruption recurred 2 years later. He was referred to Dermatology. Biopsy of one of the facial papules revealed a dense granulomatous infiltrate with surrounding prominent lymphocytes. A diagnosis of GPD was made.

OBJECTIVE AND CONCLUSION

Also known as facial Afro-Caribbean childhood eruption (FACE), GPD occurs in prepubertal children. It can be confused with sarcoidosis, infection, and granulomatous rosacea but contains lymphocytes around the granulomas and lacks the systemic involvement seen in sarcoidosis. Cultures are invariably negative. The histologic features of GPD and granulomatous rosacea can be identical, and certain treatments may exacerbate the condition, highlighting the importance of clinical correlation. The correct diagnosis is important to minimize treatment as GPD is ultimately self-limited.

Early-onset sarcoidosis mimicking refractory cutaneous histiocytosis

A 10-year-old female was diagnosed as having early-onset sarcoidosis (EOS) after a prolonged skin disease. A granuloma emerged on the face at age 2 and massive lesions extended to the rest of the body. Repeated biopsies indicated histiocytic proliferation. At age 7, fever, disseminated macular eruptions, and multinucleated giant cells in the bone marrow prompted vinblastine and prednisolone therapy. Five months after stopping therapy, hypercalcemic crisis occurred along with fever, cytopenias, and interferon-gamma-nemia indicating a macrophage activation syndrome. A biopsy of nodules confirmed the diagnosis of sarcoidosis. The atypical EOS should be differentiated from histiocytosis.

Assigning new roles to topical tacrolimus

Tacrolimus is an ascomycin macrolactam derivative with immunomodulatory and anti-inflammatory activity that belongs to the class of calcineurin inhibitors. Tacrolimus in its topical formulation has been established as a safe and effective alternative to topical corticosteroids because of its mild side effects and its minimal systemic absorption. Topical tacrolimus has been approved for the treatment of atopic dermatitis in two concentrations, 0.03 and 0.1%. In a thorough research of literature the authors review all of the available data regarding the off-label uses of the medication in other dermatoses. It seems that compared to pimecrolimus, tacrolimus has proved to be a more effective treatment. There is no causal relationship that has been established between tacrolimus and carcinogenesis. Furthermore, the authors believe that, without any evidence, the theoretical concerns are not enough to produce warnings. Tacrolimus ointment 0.1% may be recommended as a first-line choice for seborrheic dermatitis of the face and trunk, facial and intertriginous psoriasis and probably for allergic contact dermatitis and Zoon's balanitis. It has been ineffective in numerous dermatoses such as alopecia areata, necrobiosis lipoidica, internal pruritus and in thick hyperkeratotic plaques of psoriasis when administered as the commercially available formulation without occlusion. There is yet unexploited therapeutic potential regarding the use of topical tacrolimus in dermatology. Isolated cases of successful administration of the medication in various cutaneous conditions require further large-scale studies to clarify the actual effectiveness.