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
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
