Rosacea is a common, chronic condition seen most frequently in lightly pigmented skin presenting with centrofacial redness, papules, pustules, flushing, telangiectasia, and phymatous skin changes. Phymatous rosacea on the nose is called rhinophyma. This condition predominantly affects males in their 5th-7th decade of life. Rosacea has a complex pathophysiology involving the innate and adaptive immune system and its interaction with environmental stimuli. Correlation of non-melanoma skin cancer and rosacea is documented albeit uncommon, and none published from the Philippines.

This is a case of a 76-Year Old British male who presents with a 3 year history of skin colored mass on the nose, which was excised with paramedian forehead flap and was diagnosed with squamous cell carcinoma. In the interim, the patient noted the appearance of rubbery erythematous plaque on the nose with progressively increasing size and erythema and ulceration. Skin punch biopsies were done revealing both infiltrative basal cell carcinoma and rhinophyma. Patient was eventually seen by general surgery and underwent a wide excision.

This case highlights the importance of having a high index of suspicion for malignancies in the appropriate population. The different findings of biopsy sites also reminds us of choosing the appropriate biopsy sites for accurate and timely diagnosis. Lastly, a multidisciplinary approach for successful and comprehensive treatment is of paramount importance.

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.

Humans ; Skin ; Rosacea ; Patients

Introduction: Rosacea is a chronic relapsing inflammatory facial dermatosis often characterized by flare-ups and remissions exclusively affecting the centrofacial skin. Case report: This is a case of multiple symmetric intensely erythematous papules, pustules, and plaques over both cheeks in a 47-year-old Filipino female. Dermoscopy showed brown-yellowish structureless areas, straight vessels in a polygonal pattern, dilated follicles, follicular plugs, ill-defined white rosettes, and non-specific scales. Skin punch biopsy showed spongiosis of the epidermis and demodex folliculorum within the follicular infundibulum. The dermis revealed telangiectasia of blood vessels and dense inflammatory infiltrates. Hypertrophy of sebaceous lobules was also seen. The patient was initially treated with oral lymecycline 300mg twice a day for 2 weeks without improvement. Due to the persistence of centrofacial erythema, papules and pustules, the patient was given prednisone 10mg once a day for 1 month and low dose isotretinoin 10mg once a day for 8 months which resulted in significant decrease in erythema and number of existing lesions. To further decrease the inflammation con- tributed by demodex mites, permethrin 5% cream twice a day for 1 month was applied. Long-pulsed Neodymium-doped yttrium aluminum garnet (Nd:YAG) 1064 nm laser for a total of 10 sessions together with Isotretinoin 10 mg every other day effectively maintained remission for 1 year and 5 months. Gentle skin care measures, sunscreen, metronidazole 0.75% cream once a day, and desonide 0.05% cream twice a day for 1 week in cases of acute flares were maintained during the treatment course. Conclusion An armamentarium of topical and oral antibiotics, corticosteroids, isotretinoin and non-ablative long-pulsed Nd:YAG 1064 nm laser showed significant improvement in the inflammatory papules, pustules, and centrofacial erythema of rosa- cea and proves to be beneficial in the maintenance of its long-term remission.
Rosacea ; Isotretinoin ; Lymecycline

INTRODUCTION: Rhinophyma, aside from persistent centrofacial redness is a major diagnostic criteria for rosacea. Phyma may be mistaken for hypertrophy of tissue due to an underlying hemangioma. CASE REPORT: A 35-year-old female presented with few erythematous papules on the face and nose 19 years prior to consult. Lesions evolved into multiple erythematous nodules on nose and was mistaken for tissue hypertrophy due to an adjacent congenital hemangioma. Her hemangioma was treated with pulsed dye laser 16 years prior with noted decrease in size and erythema. Recently she noticed enlargement of her nose with persistent redness. She presented with multiple firm, thick irregularly shaped erythematous nodules with prominent pilosebaceous pores and telangiectasia on the nose. Skin punch biopsy was done which revealed hypertrophy and lysis of sebaceous lobules with a moderately dense inflammatory infiltrate of lymphocytes. Histopathological diagnosis was rhinophyma. Patient was treated with low dose isotretinoin (0.20 mkd) with marked flattening of lesions in just one month. CONCLUSION: Distinguishing phyma from tissue hypertrophy caused by hemangioma poses as a diagnostic challenge. Careful dermatological examination and histopathological findings will aid in correct diagnosis. Low dose oral isotretinoin is an effective treatment for rhinophyma.
Rhinophyma ; Isotretinoin ; Rosacea ; Hemangioma ; Hydrozoa

Humans ; Pedigree ; Rosacea ; pathology

BACKGROUND: Rosacea is a relatively common inflammatory skin disease characterized by central facial erythema that persists for several months or longer. Experimental studies have demonstrated that rosacea compromises the epidermal barrier protection against allergens and irritants, rendering rosacea patients susceptible to contact hypersensitivity and skin irritation. OBJECTIVE: This study aimed to investigate allergic and irritant reactions to topical agents and cosmetics in rosacea patients using patch tests. METHODS: Rosacea signs and subtypes of 40 patients were recorded and subjective symptoms and clinical experiences related to topical agents and cosmetics were assessed using a questionnaire. Patch tests were performed in these patients using the Korean Standard Series (Chemotechnique Diagnostics, Sweden), the TRUE test® (Mekos Laboratories ApS, Denmark), and 26 selected fragrance and 31 cosmetic antigens (TROLAB, Germany). RESULTS: Of 40 patch-tested patients, 26 (65%) showed at least 1 positive reaction and 13 (32.5%) showed 2 or more positive reactions. The most common allergens were nickel (II) sulfate (50%), cobalt chloride (10%), epoxy resin (7.7%), and thimerosal (7.5%). Thirteen patients (32.5%) experienced irritant patch test reactions. There were no significant differences in allergic or irritant positive reactions between mild, moderate, and severe cases of rosacea or between rosacea subtypes. Irritant reactions were more common in fair-skinned participants. CONCLUSION: Different topical medications are used in the treatment of rosacea patients. Exacerbation of rosacea may be caused by a hypersensitivity reaction or irritation induced by the topical agent or by cosmetics.
Allergens ; Clinical Study ; Cobalt ; Dermatitis, Contact ; Erythema ; Humans ; Hypersensitivity ; Irritants ; Nickel ; Patch Tests ; Rosacea ; Skin ; Skin Diseases ; Thimerosal

No abstract available.
Rosacea

BACKGROUND: Rosacea is a chronic inflammatory disease characterized by centrofacial erythema. Excess cathelicidin is suggested to be important to the pathophysiology of the disease. Recently, presence of a vitamin D response element was revealed in the cathelicidin gene promoter. OBJECTIVE: The aim of this study was to determine whether vitamin D and cathelicidin are associated with rosacea, both serologically and histopathologically. METHODS: Subjects with rosacea and without chronic skin disorders were enrolled in the patient and control groups, respectively. Serum 25-hydroxy-vitamin D and cathelicidin levels were measured. Tissue expression of cathelicidin and vitamin D receptor were measured with immunostaining-intensity-distribution index. RESULTS: The mean serum 25-hydroxyvitamin D level of patients with rosacea was 12.18±5.65 ng/ml, which is lower than that of the controls (17.41±6.75 ng/ml). Mean serum cathelicidin levels in patients with rosacea and the controls were 85.0±26.1 ng/ml and 55.0±23.3 ng/ml, respectively. Cathelicidin expression in rosacea tissue was significantly higher than that in control tissue (5.21 vs. 4.03). No significant difference was observed in vitamin D receptor expression. CONCLUSION: Higher cathelicidin expression in rosacea supports the hypothesis that an abnormal inflammatory response of the innate immune system is important in pathogenesis of rosacea, but the role of high cathelicidin serum levels is complicated. Serum vitamin D was lower in patients with rosacea, although serum cathelicidin was higher than that of the controls. This suggests that the role of vitamin D level in the pathogenesis of rosacea merits further investigation.
Erythema ; Humans ; Immune System ; Receptors, Calcitriol ; Rosacea* ; Skin ; Vitamin D Response Element ; Vitamin D* ; Vitamins*

Administration, Oral ; Anti-Bacterial Agents ; administration & dosage ; Brimonidine Tartrate ; administration & dosage ; Diagnosis, Differential ; Doxycycline ; administration & dosage ; Face ; physiopathology ; Female ; Humans ; Inflammation ; Middle Aged ; Rosacea ; diagnosis ; drug therapy ; Singapore ; Steroids ; administration & dosage ; Treatment Outcome