What treatment modalities have you had success in treating perioral or periorbital dermatitis when they have failed Topical calcineurin inhibitor and oral antibiotics?

The first line is typically metronidazole and/or clindamycin. Topical ivermectin is also a very reasonable approach, and sulfacetamide can help as well. I typically use these before topical calcineurin inhibitors. Rarely TCIs can worsen demodex as has been reported.

Which oral antibiotics? Doxycycline is most commonly used but azithromycin can work when that fails.

If a steroid is involved (topical or inhaled) that issue will need to be addressed or you are paddling upstream.

Finally, if all com...

I have had great success in periorifacial dermatitis with azithromycin on Monday, Wednesday, and Friday for four weeks. This anti-inflammatory approach in children or adult women with the appropriate dose has not failed me. It is easy to take, unlike daily doxycycline.