Control of perimenstrual flares of perioral dermatitis by isotretinoin

BACKGROUNDS: Some cases of perioral dermatitis (POD) appear in young women after the interruption of oral contraception. Perimenstrual POD flares may also occur. Blue-brown, post-inflammatory macules and atrophic scarring often persist. Conventional treatment modalities include topical and oral tetracyclines, topical metronidazole and oral contraceptives. However, such therapies mau fail or offer only transient results. Isotretinoin efficacy was reported in a patient with difficult-to-treat POD. METHODS: We studied the outcome of a 6-month course of isotretinoin with a 1-year follow-up in 14 women suffering from chronic or recurrent POD refractory to or dependent on long-term conventional treatments. The isotretinoin dosing regiments were based on acne management guidelines. RESULTS: At 1-year follow-up, 12 of 14 (85,7 %) of the women remained free of POD recurrences, one patient (7,1 %) experienced a significant improvement, and one patient (7,1 %) showed only transient improvement during therapy, and rapidly relapsed after completing two 6-month treatment courses. The muco-cutaneous side effects were similar to those already known for isotretinoin. No other adverse effects occured. CONCLUSION: Isotretinoin represents a valuable therapeutic alternative for women suffering from chronic or recurrent POD refractory to or dependent on conventional treatment options.