A Single-Center Pilot Study to Evaluate the Efficacy, Safety, and Tolerability of Sarecycline for Treating Periorificial Dermatitis

June 2025 | Volume 24 | Issue 6 | 617 | Copyright © June 2025


Published online May 29, 2025

doi:10.36849/JDD.8590

Kirsten Swenson MS MBAa,b, Emmy Graber MD MBAa,c

aThe Dermatology Institute of Boston, PC, Boston, MA
bBoston University School of Medicine, Boston, MA
cNortheastern University, Boston, MA

Abstract
Background: Periorificial dermatitis (POD) is a facial skin rash often found in the oral commissures and nasolabial folds, and around the eyes. Treatment options include topical metronidazole and azelaic acid, and oral tetracycline-class antibiotics. While the broad-spectrum antibiotics are efficacious, they can lead to adverse gastro-intestinal (GI) symptoms, negatively impact gut flora, and lead to antibiotic resistance. Narrow-spectrum tetracyclines, such as sarecycline, have a low potential for promoting bacterial resistance and GI issues.
Objective: The main objective of this study is to demonstrate sarecycline’s efficacy and safety in treating POD. It was hypothesized that subjects with POD given a 4-week course of sarecycline would have improvement in their POD and tolerate the medication well.
Methods: This was a single-center, prospective, pilot study to evaluate the efficacy, safety, and tolerability of sarecycline for the treatment of POD with once-daily dosing over 4 consecutive weeks. Subjects were evaluated using the PODSI score at weeks 0, 2, and 4.
Results: All 9 subjects who completed the study had shown improvement in POD with no reported drug-related adverse events. All subjects were female, and the mean age was 41 years old.
Conclusion: Sarecycline may be an appropriate novel treatment option for POD and should be explored further in a larger population study capturing this data. Furthermore, there is a need for more large-scale clinical studies evaluating treatment options for POD, with a focus on the impacts of antibiotic resistance and its implications on public health.

Citation: Swenson K, Graber E. A single-center pilot study to evaluate the efficacy, safety, and tolerability of sarecycline for treating periorificial dermatitis. J Drugs Dermatol. 2025;24(6):617-620. doi:10.36849/JDD.8590

INTRODUCTION

Periorificial dermatitis (POD) is an inflammatory facial dermatosis that occurs most commonly in young, female adults, yet can less frequently affect men and children. It presents as small inflammatory papules and pustules and/or dry erythematous patches in the perioral, periorbital, and perinasal areas. This rash is commonly associated with symptoms of burning and stinging, and sometimes pruritus.1

Although there is no known etiology of POD, there is a strong correlation to topical steroid use prior to the manifestation of this condition. In the case of steroid-induced POD, the first line of treatment would be to discontinue the offending agent.2 Other approaches to treatment include topical metronidazole, topical calcineurin inhibitors, azelaic acid, and oral tetracycline-class antibiotics.1 Typically, topical treatments are reserved for mild cases, and oral antibiotics are needed to treat moderate to severe presentations. However, there is no Food and Drug Administration (FDA)-indicated treatment for POD, and a lack of randomized control trials studying the treatment options. Although it can resolve quickly with treatment, improvement may be temporary as it tends to be a recurrent chronic condition.3

In the more recalcitrant cases where antibiotics are needed to treat POD, oral tetracyclines are often the first choice, specifically minocycline or doxycycline. These antibiotics are contraindicated if the patient is under the age of 8, pregnant, or breastfeeding. The tetracyclines likely work well for the treatment of inflammatory skin conditions such as acne, rosacea, and POD due to their anti-inflammatory and antimicrobial properties. Tetracycline is a first-generation tetracycline-class antibiotic, doxycycline and minocycline are second-generation tetracycline-class antibiotics, and sarecycline is a third-generation tetracycline-class antibiotic. Whereas tetracycline, doxycycline, and minocycline are broad-spectrum antibiotics, sarecycline is considered a narrow-spectrum antibiotic as it has less impact on gram-negative bacteria than its broad-spectrum counterparts.3 Sarecycline is currently FDA-indicated for the treatment of acne vulgaris in patients over the age of 9.

Tetracycline Antibiotics: Mechanism of Action3
Tetracyclines inhibit protein synthesis by inhibiting the association of aminoacyl-tRNA with a bacterial ribosome, particularly the 30S ribosomal subunit, which blocks the tRNA at the acceptor (A) site halting the elongation of the polypeptide chain.5 Sarecycline inhibits bacterial ribosomes through