Rosacea (early rhinophyma)

Diagnosis: Rosacea (early rhinophyma)

Diffuse erythema, telangiectases and papulopustules with slightly swollen tip of the nose.

Clinical Presentation

Diffuse erythema, telangiectases and papulopustules with slightly swollen tip of the nose.

Clinical History

Submitted by Alaa Saad. Originally posted September 22, 2010.

Treatment

See case discussion.

Differential Diagnosis

• Acne vulgaris • Seborrheic dermatitis • Contact dermatitis • Lupus erythematosus • Perioral dermatitis • Demodex folliculitis • Carcinoid syndrome (flushing)

Key Learnings

• Four subtypes: erythematotelangiectatic (ETR), papulopustular, phymatous, ocular • No comedones — distinguishes from acne • Demodex mites are found in increased density — role in pathogenesis supported by response to anti-parasitic therapy • Rhinophyma (phymatous rosacea) is more common in men • Ocular rosacea can be sight-threatening — evaluate all rosacea patients for eye involvement • Triggers: UV, heat, alcohol, spicy food, stress, exercise — trigger avoidance is key • Topical ivermectin and topical metronidazole are first-line topical therapies • Low-dose doxycycline (40mg modified-release) is anti-inflammatory without antibiotic activity

Tags: rosacea, early, rhinophyma, alaa saad