Azelaic acid as a new treatment for perioral dermatitis: results from an open study

Abstract

Sir, Until recently, the treatment of perioral (rosacea‐like) dermatitis has been considered to be difficult and frustrating.1 Many different substances have been employed, alone or in combination, locally or systemically. The choice has usually been occasioned by the physician's personal preferences, as the aetiology of the condition is still unknown. The mainstay of most treatment schemes has been oral tetracycline, which is effective in many cases but may be associated with adverse effects such as nausea, vomiting and phototoxicity. Topical treatments including antibiotics and metronidazole have been found useful but are not tolerated by many patients because of the unusually high skin sensitivity that often accompanies perioral dermatitis.2–4 The objective of this open clinical study was to investigate the efficacy and tolerability of a formulation containing 20% azelaic acid in 10 patients (nine women and one man; age range 32–65 years) with perioral dermatitis. At presentation, the condition had been present between 3 and 14 months. All patients had grouped erythematous papules, papulovesicles and/or papulopustules on a slightly scaling background with a distribution around the mouth, with a zone of sparing immediately adjacent to the lips. Telangiectases or comedones were not seen. There were no similar lesions on other parts of the face, especially in the periocular region. Six patients had previously used topical low‐ to high‐potency corticosteroids. Four patients had a history of atopy. All patients were negative when patch tested. Skin biopsy was performed in two patients, and showed a normal epidermis with a slight perivascular inflammatory infiltrate in the upper and mid dermis. The infiltrate consisted mainly of lymphocytes and histiocytes. No granuloma formation or Demodex mites could be demonstrated. The condition was not responsive to previous topical treatments, including antibiotics (five patients) and metronidazole (two patients). None of the patients had been given oral antibiotics.