{ "schema_version": 1, "kind": "condition", "id": "perioral-dermatitis", "name": "Perioral Dermatitis", "category": "chronic", "sources": "BAD Guidelines for Management of Rosacea and Perioral Dermatitis 2021 · Rozex 0.75% w/w Gel SmPC sections 4.2 and 4.4 (eMC product 925) · Egyptian National Drug Formulary, antimicrobial 2023, erythromycin topical monograph · Isotretinoin 10 mg capsules, soft SmPC sections 4.3 and 4.4 (eMC product 100769) · Perioral Dermatitis - StatPearls - NCBI Bookshelf (NBK525968), corroborated by Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph) · Perioral Dermatitis - StatPearls - NCBI Bookshelf (NBK525968), with the 250 mg capsule form from Egyptian National Drug Formulary - Antimicrobial 2023 (tetracycline monograph)", "review_status": "reviewed", "verified_against": "Rozex 0.75% w/w Gel SmPC sections 4.2 and 4.4 (eMC product 925) · Egyptian National Drug Formulary, antimicrobial 2023, erythromycin topical monograph · Perioral Dermatitis - disease-level clinical article (perioral-dermatitis-full.txt) · Perioral Dermatitis - disease-level clinical article (perioral-dermatitis-clinical.txt) · Isotretinoin 10 mg capsules, soft SmPC sections 4.3 and 4.4 (eMC product 100769)", "verified_date": "2026-08", "treatments": [ { "id": 1425, "generic": "Metronidazole", "line": 1, "is_adjunct": false, "form": "topical", "strength_mg": null, "adult_dose": "Apply 0.75% gel/cream twice daily to clean skin", "adult_duration": "3 to 4 months", "dose_source": "Rozex 0.75% w/w Gel SmPC sections 4.2 and 4.4 (eMC product 925)", "rationale": "Topical metronidazole has antimicrobial and anti-inflammatory action that helps clear perioral dermatitis once all facial corticosteroids, the usual trigger, have been stopped.", "cautions": [ "ZERO TOLERANCE: Immediately stop ALL topical corticosteroids on face (primary precipitating factor).", "Warn patient of initial rebound flare when stopping topical steroids.", "Avoid harsh facial cleansers, cosmetics, and fluorinated toothpastes.", "Rosacea takes time - the label puts the average course at three to four months, and it may be continued beyond that if it is clearly working. Keep treated skin out of the sun." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not recommended in children (safety and efficacy not established).", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "ROSAGEL 0.75% GEL 20 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EVA PHARMA", "price_egp": 11.5, "pack_count": null, "unit_price": null, "strength_mg": 20000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FIPCODAZOLE 10 MG GEL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "D B K > BOSTON HEALTH", "price_egp": 62.0, "pack_count": null, "unit_price": null, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "perioral-dermatitis" }, { "id": 1427, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Perioral Dermatitis - disease-level clinical article (perioral-dermatitis-full.txt)", "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.", "cautions": [ "RED FLAG - Topical corticosteroids should not be used for perioral dermatitis - they can trigger or worsen it, and cause a rebound flare if withdrawn abruptly. A clinically important pitfall, since steroids are a classic cause of this condition." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "perioral-dermatitis" }, { "id": 1426, "generic": "Erythromycin", "line": 2, "is_adjunct": false, "form": "topical", "strength_mg": null, "adult_dose": "Apply 2% solution/gel twice daily", "adult_duration": "6-8 weeks", "dose_source": "Egyptian National Drug Formulary, antimicrobial 2023, erythromycin topical monograph", "rationale": "Topical erythromycin is a macrolide antibiotic used as an alternative to metronidazole for perioral dermatitis in patients who cannot tolerate it.", "cautions": [ "Both packs listed below are withdrawn. Ask instead for ACNE BIOTIC PAINT or ACNE ZINC TOPICAL SOLUTION, which are erythromycin with zinc acetate and are still marketed - they do not appear in the list because the national file records no route for them. Egypt has no plain topical erythromycin, and the other live combinations add isotretinoin or salicylic acid, neither of which belongs on an inflamed face.", "Erythromycin is an effective topical antibiotic alternative for metronidazole-intolerant patients.", "Gentle skincare with soap-free cleanser is essential.", "If refractory, consider oral doxycycline 100 mg daily for 6-8 weeks (adults only).", "Topical erythromycin alone breeds resistance. Pair it with something else rather than running it as the only agent, and stop at 6-8 weeks if nothing has changed." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Apply twice daily after washing face", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "AKNEMYCIN 2% OINT. 15 GM (N/A)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP > HERMAL-GERMANY", "price_egp": 5.0, "pack_count": null, "unit_price": null, "strength_mg": 15000.0, "exact_strength": true, "exact_form": true, "discontinued": true, "also_contains": null }, { "trade_name": "ACNI-CARE 2% TOP. GEL. 20 GM (N/A)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA", "price_egp": 6.5, "pack_count": null, "unit_price": null, "strength_mg": 20000.0, "exact_strength": true, "exact_form": true, "discontinued": true, "also_contains": null } ], "condition_id": "perioral-dermatitis" }, { "id": 1429, "generic": "Doxycycline", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 100.0, "adult_dose": "100 mg once or twice a day, swallowed with plenty of water and not lying down afterwards", "adult_duration": "8 to 12 weeks, tapering the dose down over the course", "dose_source": "Perioral Dermatitis - StatPearls - NCBI Bookshelf (NBK525968), corroborated by Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph) - verbatim: \"Oral: IR and most ER formulations: 100 to 200 mg/day in 1 to 2 divided doses.\"", "rationale": "Perioral dermatitis that has not answered topical metronidazole or erythromycin needs a systemic tetracycline before anyone considers isotretinoin. Doxycycline is the easiest of them to take, once or twice daily rather than four times.", "cautions": [ "Contraindicated in children under 8, in the second and third trimesters of pregnancy, and while breastfeeding.", "It photosensitises, which matters on a Cairo face - warn about sun exposure and advise a sunscreen for the whole course.", "Swallow it with a full glass of water and stay upright afterwards, or it can ulcerate the oesophagus.", "Antacids, calcium, iron and magnesium block its absorption - separate them by several hours." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not for children younger than 8 - tetracyclines are contraindicated in that age group, and the article names it as a reason to use erythromycin instead.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "FARCODOXIN 100MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 11.0, "pack_count": 10, "unit_price": 1.1, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DOXY M.R.100 MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ADWIA", "price_egp": 12.0, "pack_count": 10, "unit_price": 1.2, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GRANUDOXY 100MG 10 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL NAPI PHARMACEUTICALS > PIERRE FRANCE", "price_egp": 12.0, "pack_count": 10, "unit_price": 1.2, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DOXYDOX 100 MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 23.0, "pack_count": 10, "unit_price": 2.3, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DOXYMYCIN 100 MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE.", "price_egp": 30.0, "pack_count": 10, "unit_price": 3.0, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TABOCINE 100MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "TABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA", "price_egp": 46.0, "pack_count": 10, "unit_price": 4.6, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VIBRAMYCIN 100MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PFIZER", "price_egp": 65.0, "pack_count": 10, "unit_price": 6.5, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "perioral-dermatitis" }, { "id": 1430, "generic": "Tetracycline", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 250.0, "adult_dose": "250 to 500 mg twice a day on an empty stomach", "adult_duration": "8 to 12 weeks, tapering the dose down over the course", "dose_source": "Perioral Dermatitis - StatPearls - NCBI Bookshelf (NBK525968), with the 250 mg capsule form from Egyptian National Drug Formulary - Antimicrobial 2023 (tetracycline monograph)", "rationale": "Same class and same course as doxycycline but a fraction of the price, which decides it for many patients in Cairo. The trade-off is a strict empty-stomach schedule that patients keep less well.", "cautions": [ "Contraindicated in children under 8, in the second and third trimesters of pregnancy, and while breastfeeding.", "Take it on an empty stomach, and never with milk, antacids, calcium or iron, which bind it and stop it working.", "It photosensitises - warn about sun exposure over an 8 to 12 week course.", "Avoid it in renal impairment; unlike doxycycline it accumulates when the kidneys are poor." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not for children younger than 8 - tetracyclines are contraindicated in that age group, and the article names it as a reason to use erythromycin instead.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "TETRACYCLINE HCL 250 MG 16 CAPS. USP 24", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NASR", "price_egp": 11.0, "pack_count": 16, "unit_price": 0.69, "strength_mg": 250.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TETRACID 250 MG 16 CAP.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CID", "price_egp": 22.0, "pack_count": 16, "unit_price": 1.38, "strength_mg": 250.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TETRACYCLINE 250 MG 12 CAPS. (ADCO)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB DRUG COMPANY (ADCO)", "price_egp": 16.5, "pack_count": 12, "unit_price": 1.38, "strength_mg": 250.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TETRACYCLINE 250 MG 240 CAPS. (ADCO)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB DRUG COMPANY (ADCO)", "price_egp": 462.0, "pack_count": 240, "unit_price": 1.93, "strength_mg": 250.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "perioral-dermatitis" }, { "id": 1428, "generic": "Isotretinoin", "line": 3, "is_adjunct": false, "form": "oral.solid", "strength_mg": null, "adult_dose": "initially 0.2 mg/kg per day, tapering to 0.1 to 0.05 mg/kg per day", "adult_duration": null, "dose_source": "Perioral Dermatitis - disease-level clinical article (perioral-dermatitis-clinical.txt)", "rationale": "Low-dose oral retinoid reserved for severe or recalcitrant perioral dermatitis unresponsive to topical and oral antibiotic therapies.", "cautions": [ "Teratogenic: strictly contraindicated in pregnancy; highly effective contraception required.", "Monitor liver enzymes and fasting serum lipids on a schedule. Label verbatim (Isotretinoin 10 mg capsules SmPC section 4.4): \"Liver enzymes should be checked before treatment, 1 month after the start of treatment, and subsequently at 3 monthly intervals unless more frequent monitoring is clinically indicated.\" and \"Serum lipids (fasting values) should be checked before treatment, 1 month after the start of treatment, and subsequently at 3 monthly intervals unless more frequent monitoring is clinically indicated.\"", "CONTRAINDICATED beyond pregnancy, same label section 4.3: \"With hepatic insufficiency\" ( EGYPHARMA-EGYPT", "price_egp": 87.0, "pack_count": 30, "unit_price": 2.9, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ROACCUTANE 10 MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "F.HOFFMAN LA ROCHE", "price_egp": 126.0, "pack_count": 30, "unit_price": 4.2, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ROACCUTREX 20 MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEDIZEN PHARMACEUTICAL INDUSTRIES > EGYPHARMA-EGYPT", "price_egp": 161.0, "pack_count": 30, "unit_price": 5.37, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ACNELOFIX 20 MG 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MELANO PHARMA", "price_egp": 270.0, "pack_count": 20, "unit_price": 13.5, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ISOTRETAM 10 MG 20 S.G. CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEDIZEN", "price_egp": 115.0, "pack_count": null, "unit_price": null, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ISOTRETINOIN 10MG 30 SOFT GELATIN CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SUN PHARMA EGYPT LIMITED > RANBAXY", "price_egp": 192.0, "pack_count": null, "unit_price": null, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ISOTRETINOIN 20MG 30 SOFT GELATIN CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SUN PHARMA EGYPT LIMITED > RANBAXY", "price_egp": 372.0, "pack_count": null, "unit_price": null, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NETLOOK 40MG 20 SOFT GELATIN CAPSULE", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEDIZEN PHARMACEUTICAL INDUSTRIES > ANDALOUS PHARMA", "price_egp": 394.0, "pack_count": null, "unit_price": null, "strength_mg": 40.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "perioral-dermatitis" } ] }