This condition most often affects pre-pubescent children. Histologically, granulomatous periorificial dermatitis and granulomatous rosacea can be indistinguishable. It has been hypothesized that the two diseases are simply variations of the same disease process that lie along a spectrum.1 Erythema, telangiectasias, pustules and edema are more commonly found in granulomatous rosacea while granulomatous dermatitis typically presents with small red or brown clustered papules.2,3 Treatment of these granulomatous lesions, particularly granulomatous periorificial dermatitis, is controversial. The pathogenesis of GPD is believed to be closely linked to topical steroid use, and it has been reported that the use of steroids exacerbates GPD lesions.4 However, our patient experienced marked improvement in the perioral lesion in response to intralesional steroid injections with resolution of pustules and a decrease in erythema and induration within three days of treatment. While steroids may or may not play a role in the pathogenesis of GPD, this case suggests that intralesional steroids should be considered for patients suffering from localized GPD or granulomatous rosacea refractory to other therapies.
E. Marmur has financial relationships with Revance, Galderma, Auergan, Merz, and MM Skincare. S. von Csiky-Sessoms has no conflicts.
1. Savin JA, Alexander S, Marks R. A rosacea-like eruption of children. Br J Dermatol. 1972;87(5):425-29 doi: 10.1111/j.1365-2133.1972.tb01589.x
2. Urbatsch AJ, Frieden I, Williams ML, Elewski BE, Mancini AJ, Paller AS. extrafacial and generalized granulomatous periorificial dermatitis. Arch Dermatol. 2002;138(10):1354-58 doi: 10.1001/archderm.138.10.1354
3. Lucas CR, Korman NJ, Gilliam AC. Granulomatous periorificial dermatitis: a variant of granulomatous rosacea in children? J Cutaneous Med Surg. 2009;13(2):115-18 doi: 10.2310/7750.2008.07088
4. Zalaudek I. Childhood granulomatous periorificial dermatitis: a controversial disease. J der Deutschen Dermatologischen Gesellschaft;3(4):252-55