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? Doxycycl...

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.