The treatment of refractory periorbital dermatitis

PURPOSE: Refractory periorbital dermatitis has a chronic course with exacerbations leading to discomfort and cosmetic issues, yet characterization of treatment options is limited. AIMS: The objective was to present comprehensive demographic data and medical management of a series of patients with refractory periorbital dermatitis. SETTINGS AND DESIGN: Retrospective review identified patients treated at a single institution from January 2010 to August 2020. METHODS: Descriptive analyses were performed. Demographic data and treatment history were reviewed and data including medication, use, date of use and discontinued use, reason for discontinuation (if applicable), refractory status, formulation, concentration, and dose frequency were extracted. STATISTICAL ANALYSIS USED: Descriptive analyses. RESULTS: Forty-five patients were included. The average age at first diagnosis was 60.3 years (sd 14.9). 82.2% were women and 84.4% identified as Caucasian. Triamcinolone cream was most frequently used followed by tobramycin–dexamethasone, tacrolimus, and neomycin–polymyxin–dexamethasone. Less than 30% of patients on triamcinolone were refractory. 13.3% of patients used topical hydrocortisone, with over 80% of these patients experiencing refractory episodes of persistent irritation and erythema. Most patients were refractory during initial use or the first recurrence of periorbital dermatitis flare. CONCLUSIONS: By better characterizing the diverse treatment regimens in a unique subset of refractory patients, we hope to better inform potential courses of medical management for periorbital dermatitis.