The correct answer is A. Oral doxycycline for 6-12 weeks.

Periorificial dermatitis is a common facial skin problem characterized by groups of itchy or tender small red papules. It is given this name because the papules occur around the eyes, the nostrils, the mouth, and occasionally, the genitals.

In more severe cases, a course of anti-inflammatory oral antibiotics may be prescribed for 6–12 weeks as the first-line treatment. This also helps to reduce the rebound flare seen after stopping the topical steroid.

Topical therapy is used to treat mild periorificial dermatitis. Choices include: clindamycin, erythromycin, metronidazole, pimecrolimus, and azelaic acid. Oral low-dose isotretinoin may be used if antibiotics are ineffective or contraindicated.

References:

Hall CS, Reichenberg J. Evidence based review of perioral dermatitis therapy. G Ital Dermatol Venereol. 2010;145(4):433-44. PubMed PMID: 20823788.
Maeda A, Ishiguro N, Kawashima M. The pathogenetic role of rod-shaped bacteria containing intracellular granules in the vellus hairs of a patient with perioral dermatitis: a comparison with perioral corticosteroid-induced rosacea. Australas J Dermatol. 2016;57(3):225-8. doi:10.1111/ajd.12344. PubMed PMID: 25894304.

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