Tuesday, August 18, 2015

Unilateral Facial Erythema

The patient is a 27 yo woman with a 3 year history of facial erythema, restricted, for the most part to the right cheek.  She is a pharmacist assistant, takes no meds by mouth other than thyroid.  She took doxycyclinc  a few years back but stopped because of G.I. upset and topical metronidazole was not helpful

Exam showed dramatic erythema of the right cheek and malar eminence.  There are no papules or pustules.  The left side of the face appears normal.

Clinical Images:

Diagnosis: Unilateral Telangiectatic Rosacea or Unilateral Facial Telangiectasia

1. Unilateral Swelling and Erythema of the Face.
Burgess N. Proc R Soc Med. 1938 Dec;32(2):85-6.

2. Unilateral demodectic rosacea.  Shelley WB1, Shelley ED, Burmeister V.  J Am Acad Dermatol. 1989 May;20(5 Pt 2):915-7.
Abstract: A unilateral rosacea-like chronic dermatitis of the right side of the face was shown to harbor innumerable Demodex folliculorum and D. brevis. Treatment with oral metronidazole suppressed the dermatitis but did not significantly reduce the Demodex population. Treatment with topical crotamiton eliminated the Demodex and was curative. These observations support the view that D. folliculorum and D. brevis may be pathogenic when they are present in extremely large numbers.

We could find no useful articles on unilateral rosacea without papules or pustules. Perhaps, even so, a scraping for demodex mites should be done. 

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