Issues in Dermatology
These Experts share problem-solving insights about their most
challenging acne and rosacea cases.
April 2002
A 60-year-old man presents with a 1-year history of minute papules and pustules on a red, swollen 2-cm diameter area on the mid-third of his right cheek. He has 2+ actinic damage with increased seborrhea and telangiectatic vessels on the remainder of his face. He also complains of frequent flushing and blushing and constant eye irritation, requiring frequent over-the-counter lubricating eye drops.
Diagnosing the Condition
This patient’s history of flushing and blushing with chronic eye discomfort is most compatible with a diagnosis of classic rosacea. But the lesion on the right cheek is a little-known variant of rosacea, which is called plaque rosacea. This condition presents as a unilateral, asymptomatic, erythematous, well-
circumscribed but diffuse-bordered edematous area, usually containing inflammatory papules and
pustules.
Differential Diagnosis
Be sure to include erysipelas, recurrent herpes simplex virus, granuloma faciale and sarcoid in your differential diagnosis.
Treatment
Plaque rosacea responds nicely to routine rosacea medications.
In this particular case, the patient underwent therapy with doxycycline monohydrate (Monodox) 100 mg per day in addition to topical metro-
nidazole 0.75% gel b.i.d.
A 60-year-old man presents with a 1-year history of minute papules and pustules on a red, swollen 2-cm diameter area on the mid-third of his right cheek. He has 2+ actinic damage with increased seborrhea and telangiectatic vessels on the remainder of his face. He also complains of frequent flushing and blushing and constant eye irritation, requiring frequent over-the-counter lubricating eye drops.
Diagnosing the Condition
This patient’s history of flushing and blushing with chronic eye discomfort is most compatible with a diagnosis of classic rosacea. But the lesion on the right cheek is a little-known variant of rosacea, which is called plaque rosacea. This condition presents as a unilateral, asymptomatic, erythematous, well-
circumscribed but diffuse-bordered edematous area, usually containing inflammatory papules and
pustules.
Differential Diagnosis
Be sure to include erysipelas, recurrent herpes simplex virus, granuloma faciale and sarcoid in your differential diagnosis.
Treatment
Plaque rosacea responds nicely to routine rosacea medications.
In this particular case, the patient underwent therapy with doxycycline monohydrate (Monodox) 100 mg per day in addition to topical metro-
nidazole 0.75% gel b.i.d.
A 60-year-old man presents with a 1-year history of minute papules and pustules on a red, swollen 2-cm diameter area on the mid-third of his right cheek. He has 2+ actinic damage with increased seborrhea and telangiectatic vessels on the remainder of his face. He also complains of frequent flushing and blushing and constant eye irritation, requiring frequent over-the-counter lubricating eye drops.
Diagnosing the Condition
This patient’s history of flushing and blushing with chronic eye discomfort is most compatible with a diagnosis of classic rosacea. But the lesion on the right cheek is a little-known variant of rosacea, which is called plaque rosacea. This condition presents as a unilateral, asymptomatic, erythematous, well-
circumscribed but diffuse-bordered edematous area, usually containing inflammatory papules and
pustules.
Differential Diagnosis
Be sure to include erysipelas, recurrent herpes simplex virus, granuloma faciale and sarcoid in your differential diagnosis.
Treatment
Plaque rosacea responds nicely to routine rosacea medications.
In this particular case, the patient underwent therapy with doxycycline monohydrate (Monodox) 100 mg per day in addition to topical metro-
nidazole 0.75% gel b.i.d.
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