Clinical Cases

Case 1

Initial Presentation

  • 55-year-old woman
  • Chronic persistent erythema with occasional intensification and telangiectasias on the cheeks and nose
  • Not responding to topical antibiotics

Diagnosis

Rosacea (1 diagnostic phenotype: persistent centrofacial erythema and 1 majorphenotype: telangiectasia)

Treatment

  • Discontinue topical antibiotics
  • Topical brimonidine 0.33% gel (such as Mirvaso)
  • Photoprotection, sunscreen use advised, appropriate skin care (gentle facial cleanser and moisturizer)
  • Discuss options for laser or IPL treatment
  • Identify and avoid triggers of flushing

Follow-up

At 6 weeks:

  • Improvement of persistent erythema
  • Telangectasias continue to persist and patient opts for laser treatment
  • She will conitnue sun protection and topical brimonidine at home and return every 3-6 weeks for repeat laser treatment as needed

Case 2

Initial Presentation

  • 40-year-old woman
  • Long-standing erythematous papules and plaques on the cheeks, nose, chin, forehead
  • Skin lesions are exacerbated by sun exposure and alcohol consumption
  • No response to topical antibiotics alone

Diagnosis

Rosacea

Treatment

  • Start topical ivermectin 1% cream (such as Soolantra) applied once daily
  • Photoprotection, sunscreens advised. Appropriate skin care (gentle facial cleanser and moisturizer)
  • Avoid alcohol consumption, sun exposure

Follow-up

At 6 weeks:

  • Lesions improved
  • Continue topical ivermectin cream
  • Continue photoprotection and skin care
  • Continue to avoid alcohol consumption and other triggers

Case 3

Initial Presentation

  • 25-year-old woman
  • Recurrent erythematous papules on cheeks, nose, forehead
  • Also with signs of blepharitis, conjunctival erythema and edema and complaints of  foreign body sensation in the eyes bilaterally
  • Topical antibiotic lotion alleviates skin but not ocular symptoms
  • No clear triggers for symptoms

Diagnosis

Rosacea with ocular symptoms (2 major phenotypes: inflammatory papules, ocular manifestations)

Treatment

  • Doxycycline 40 mg by mouth twice a day (oral doxycycline are first-line treatment for ocular rosacea)
  • Metronidazole 1% cream or gel applied once a day to affected areas on the cheeks, nose and forehead
  • Photoprotection, including UV-protective sunglasses and sunscreen of SPF 30+ advised. Appropriate skin care with gentle facial cleanser and moisturizer. Eyelid hygiene with warm compresses and diluted baby shampoo soaks
  • Consider referral to an ophthalmologist if needed

Follow-up

At 6 weeks:

  • Lesions improved, no ocular signs present
  • Continue metronidazole 1% cream or gel applied once daily to skin lesions
  • Continue photoprotection and skin car