Rosacea variantsLupus Miliaris Disseminatus Faciei | Figure 3.5
A: Lupus miliaris disseminatus
faciei
(Courtesy of Dr. Iris K.
Aronson)
B: Pyoderma faciale
(Courtesy of Dr. Paul Getz)
C: Plaque psoriasis |
- Yellow-brown to red small monomorphic smooth papules on malar cheeks and periorifically
- Lack history of flushing and lack telangiectasias
- Histology: prominent small granulomas, ± central necrosis or caseation
- Treatment: long term therapy with minocycline or isotretinoin
Pyoderma Faciale (Rosacea Fulminans) (Figure 3.5B) - Mainly seen in postadolescent females; may be rare variant of rosacea
- Presents with acute onset of erythematous papules, pustules, nodules and abscesses in centrofacial region with background of dull cyanotic erythema, ± draining sinuses; ± mild systemic symptoms (myalgias, fever, ↑ ESR, ↑ WBC)
- Treatment: initial use of oral corticosteroid followed by low-dose isotretinoin and slow taper of corticosteroid
Morbihan’s Disease (Solid Facial Edema)- Presents with woody, nonscaling edema involving midline face and cheeks
- Treatment: isotretinoin ± ketotifen × 4–5 months
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