Wednesday, January 04, 2006

Explosive Rosacea?

The patient is a 33 year-old executive V.P. who presents with a 6 month history of dramatic facial eruption. He had acne as a teenager but has been clear for many years. His health is good and he takes no medication by mouth. He has never used topical corticosteroids for his face.


The examination shows erythematous papules and small cysts on forehead, cheeks and chin. There are a few papules on the back, but the chest is clear.






Diagnosis: Florid Rosaca

Plan:
I will place on prednisone 20 mg bid for a week or so and isotretinoin 0.25 mg per kg for a cple of weeks and then increase to 0.5 mg per kg fir a month or two. Slowly incvrease isotretinolin to 1 mg per kg over 8 weeks and anticipate a six moth course. The prednisone will be tapered over a month to 6 weeks to avoid a flare.

I could have started with doxycycline; but isotretinoin may be more definitive; I welcom your thoughts.

Thank you,

David

3 comments:

  1. Interesting case - thanks for sharing. I would add a topical metronidazole, and if he's not much better in 3months, consider biopsy for lupus.

    Cheers, Ben

    ReplyDelete
  2. Great pics. Agree with dx, although my approach to rosacea is different; my favorite is still tetracycline and in the case of predominance of pustular lesions, i always try to look for demodex. Cheers, omid

    ReplyDelete
  3. Very nice photos,no doubt,this is rosacea but my plan for treatment even for florid case is to use septrin tab 2 twice a day for 2 weeks then once a day together with flagyl tab 250 twice a day for one month with or with out topical Dalacin c sol.All patients they respond to this regeme.Then over time this therapy will be tapered until we have full remission.I do not use isotretinoin for my patients.As alternative,I might use oral zinc sulfate 100mg twice a day which proved its effectiveness.
    khalifa sharquie

    ReplyDelete

We welcome your comments. We endeavor to serve your patients and you. If you want us to respond, please add your name and email address. Some people have trouble uploading comments. In that case, please send comments directly to djelpern@gmail.com. Thank you.