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Virtual Medical LibraryA 27-year-old woman comes to the physician because of a rash around her mouth for 4 months. She initially applied over-the-counter hydrocortisone 1% cream daily, which helped briefly, but the rash flares within days whenever she stops it. She has no history of acne and takes no oral medications. Vital signs are normal. Examination shows clusters of 1- to 2-mm erythematous papules and pustules on the perioral skin and nasolabial folds, with a narrow band of uninvolved skin immediately adjacent to the vermilion border; there are no comedones, telangiectasias, or vesicles. Which of the following is the most appropriate management?
Explanation. Perioral dermatitis presents as tiny papulopustules around the mouth, nose, or eyes with characteristic sparing of the skin adjacent to the vermilion border. It is frequently triggered by topical, inhaled, or nasal corticosteroids. Management is to stop the steroid (warning of a flare) and use topical metronidazole, azelaic acid, or pimecrolimus, or oral doxycycline for extensive disease.
Educational objective: Perioral papulopustules sparing the vermilion border + steroid cream = perioral dermatitis; stop the steroid.
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