A 7-year-old boy presented to the dermatology department with a 6-month history of an asymptomatic rash around the mouth. Initially, he had been treated with topical corticosteroids. However, the eruption worsened and spread to the lower eyelids 1 month before presentation. Physical examination revealed monomorphous erythematous papules distributed over the perioral and periorbital regions (Fig. 1A). A skin biopsy specimen obtained from the left chin demonstrated upper dermal and perifollicular granulomas admixed with lymphocytes (Fig. 2). Special stains, including periodic acid–Schiff and acid-fast stains, were negative. A diagnosis of childhood granulomatous periorificial dermatitis was established.
Childhood granulomatous periorificial dermatitis is a rare acneiform eruption that predominantly affects prepubertal children. The exact pathogenesis remains unclear; however, secondary ocular involvement and rosacea-like histopathologic findings have led some authors to suggest an association with rosacea. Topical or inhaled corticosteroid use has been identified as a potential triggering factor. In children, oral erythromycin or azithromycin may be effective in severe cases. Counseling regarding the benign nature of the condition is important, as lesions may persist for several months.
At the 6-month follow-up visit, after discontinuation of topical corticosteroids and initiation of oral erythromycin therapy, the skin lesions had markedly improved (Fig. 1B).
