Unilateral rosacea is a rare type of rosacea that affects only one side of the face. Limited literature exists on this condition which resembles classic rosacea with persistent erythema, papules, or pustules but shows an unusual asymmetric pattern. The cause is unclear though localized triggers or vascular differences may be involved, complicating diagnosis due to similarities with other conditions.

This is a case of a 42-year-old male who presented with a 4-year history of few ill-defined erythematous patches topped with yellowish papules on the right side of his face and neck. On initial consult, he was noted to have a history of prolonged esun exposure. A skin punch biopsy was done and revealed basal layer hyperpigmentation, pigment incontinence and lymphohistiocytic cell aggregates in the dermis, consistent with granulomatous dermatitis. There was no Demodex infestation. Based on clinical and histopathological data, the diagnosis was unilateral rosacea. Treatment in this case included topical Azelaic Acid cream and frequent sunscreen application along with physical photoprotection, avoidance of unnecessary and prolonged sun exposure.

First reported in 1989 by Shelley et al., unilateral rosacea is underreported, making it challenging to estimate its prevalence. It affects middle-aged adults and can be confused with other unilateral skin conditions. However, no specific data or large-scale studies have been dedicated solely to unilateral cases and it may be mistaken for other unilateral skin conditions making the diagnosis challenging. Treatment generally follows the rosacea protocols like topical therapies, oral medications and lifestyle modification.

Human ; Male ; Adult: 25-44 Yrs Old ; Rosacea

Bowen’s Disease, or squamous cell carcinoma in situ, is a premalignant skin condition characterized by atypical keratinocyte proliferation confined to the epidermis. It presents as scaly, erythematous plaque resembling benign disorders like eczema or psoriasis, complicating diagnosis. Early treatment is vital to prevent progression to invasive carcinoma.

A 60 year old female with prolonged sun exposure presented with a 17-year history of a solitary pinkish patch on her right lower abdomen. Initially non-pruritic and non-tender, the lesion gradually enlarged and thickened, developing into a pruritic plaque. She was treated with Mupirocin ointment without improvement. Three years thereafter, plaque showed hyperpigmentation, scaling, and increased pruritus. Self-treatment various topicals daily for one month was ineffective, prompting further evaluation. Physical examination revealed ill-defined hyperpigmented plaques with irregular borders, scaling, crusting, and hyperkeratosis on the right lower abdomen. A skin punch biopsy showed basketweave stratum corneum with scale crust, spongiotic epidermis with multiple atypical keratinocytes, and dermal infiltrates of atypical mononuclear cells, lymphohistiocytic cells, eosinophils, melanophages, dilated vessels, and extravasated erythrocytes. Diagnosis of in-situ squamous cell carcinoma. Treated with Imiquimod 5% cream three times weekly, achieving complete regression and no recurrence at six months.

Bowen’s Disease mainly affects older adults with significant sun exposure, aligning with higher incidence in chronically sun-damaged populations. Histopathology with atypical keratinocytes confined to the epidermis differentiates it from invasive carcinoma. Topical Imiquimod, an immune response modifier, effectively induced lesion regression by stimulating local cytokines. This case highlights the importance of early diagnosis and non-invasive treatment to prevent malignant progression.

Human ; Female ; Middle Aged: 45-64 Yrs Old ; Imiquimod ; Carcinoma, Squamous Cell