Periorificial Dermatitis Successfully treated with Novel Nar
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A 31-year-old female with underlying Crohn’s disease was evaluated for dry pink scaling patches at her oral commissures that were believed to be consistent with angular cheilitis. Triamcinolone acetonide 0.1% topical ointment for no more than five days of use was recommended. Her skin completely improved, and she discontinued the triamcinolone within five days. Approximately 13 days later, the patient noted self-described blisters to the cheeks and around lips. She was seen in clinic twenty days after her telemedicine visit for a burning sensation and a large pink shiny patch around her mouth and many tiny satellite pink papules on her cheeks.

A punch biopsy was performed, and histopathology was consistent with the suspected diagnosis of POD. Careful consideration of treatment was discussed with the patient due to her underlying Crohn’s disease. The patient reported that she took oral doxycycline in the distant past just prior to her inflammatory bowel disease diagnosis. At the time of presentation of her rash, her Crohn’s symptoms were well controlled with infliximab infusions. However, doctors were concerned that her Crohn’s symptoms may flare with doxycycline and were hesitant to prescribe a broad-spectrum antibiotic, such as doxycycline, with gastrointestinal consequences.

In effort to decrease the likelihood of causing a Crohn’s flare secondary to broad-spectrum antibiotic use, the patient was prescribed the narrow spectrum antibiotic, sarecycline 100mg PO qday. Sarecycline was chosen because it is also a member of the tetracycline family and therefore, doctors hoped that it would have a similar effect on POD as doxycycline, yet without the side effects of a broad-spectrum antibiotic.

The patient returned to clinic five days after starting sarecycline and already had significant improvement of her POD and resolution of her burning symptoms. The patient denied gastrointestinal upset or any symptoms indicative of a Crohn’s exacerbation. Eight days later, the patient supplied photos demonstrating almost complete resolution of the periorificial dermatitis after only 13 total days of sarecycline use.

Sarecycline is currently only FDA-approved and indicated for moderate to severe acne vulgaris and is the only narrow spectrum antibiotic in the tetracycline family of antibiotics.