Granulomatous Perioral Dermatitis or Sarcoid?

To the Editor.—  We read with interest the Off-Center Fold entitled "Papular Midfacial Eruption in a Child" that appeared in the December 1989 issue of the Archives.¹ The clinical and histopathologic findings in this case are virtually identical to five cases we reported in the March 1989 issue of the Archives as cases of granulomatous perioral dermatitis in children, and we believe that this entity, not sarcoid, is the correct diagnosis in this case.²The distinction between these conditions is not merely a semantic one. Granulomatous perioral dermatitis is a variant of perioral dermatitis, which is self-limited and can either be left untreated, or treated with innocuous medications such as topical hydrocortisone and/or oral erythromycin. Sarcoidosis, on the other hand, is often treated with a variety of more potent medications, including fluorinated topical corticosteroids, that can actually worsen perioral dermatitis. It may also be treated with intralesional and