Abstract:

We present a case of a 38-year-old female with no significant past medical history presenting for evaluation of a rash on her face that had been present for 6 months. The rash was itchy, burning, painful, swollen, and had purulent drainage. She endorsed joint pains and a family history of lupus in her brother and mother. A brother had a similar rash that was biopsied and was reportedly consistent with lupus. Physical examination demonstrated erythematous papules and pustules coalescing into plaques on the bilateral cheeks, forehead, temples, nose, and neck. Mineral oil prep was negative for Demodex mites. The differential diagnosis included granulomatous rosacea, lupus erythematosus, and rosacea fulminans. A punch biopsy was performed. Histologic sections demonstrated a brisk perivascular and perifollicular lymphohistiocytic infiltrate with mixed acute and granulomatous inflammation. Demodex mites and Pityrosporum yeast were present within the dilated follicular ostia. The histological findings are consistent with rosacea fulminans. Rosacea fulminans is an uncommon skin condition that most commonly affects women in their 20s-30s. It is characterized by the sudden onset of inflamed papules, pustules, and nodules and corresponding erythema of the nose, chin, and malar regions. Treatment options include oral and topical steroids, oral antibiotics, and isotretinoin. It is important to identify and treat this condition early to prevent scarring and further psychological stress.

Financial Disclosure:
No current or relevant financial relationships exist.

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Brigette Lee, MD