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Patient Case: Acne Rosacea

Patient Case: Acne Rosacea

Discussion

A 45-year-old woman presents to the dermatology clinic with persistent redness and small bumps on her cheeks and nose. She reports that her skin has been gradually worsening over the past year, with frequent episodes of flushing triggered by hot drinks, spicy foods, and sun exposure. She denies any blackheads or deep cystic lesions but complains of a burning sensation on her face.

On examination, erythema (redness), telangiectasia (visible small blood vessels), and scattered papules and pustules are noted on the central face, particularly on the cheeks and nose. There are no comedones, and the skin appears sensitive. No ocular symptoms are reported.

A diagnosis of papulopustular rosacea is made. The patient is advised to avoid triggers such as alcohol, spicy foods, and excessive sun exposure. Treatment is initiated with topical metronidazole and sunscreen, with the option of adding oral doxycycline if symptoms worsen. She is counseled on the chronic nature of rosacea and the importance of gentle skincare and lifestyle modifications.

Questions
  1. What is the most likely diagnosis for this patient?
    a) Acne vulgaris
    b) Rosacea
    c) Seborrheic dermatitis
    d) Perioral dermatitis
  2. Which clinical feature is most characteristic of rosacea?
    a) Open and closed comedones
    b) Persistent facial erythema with telangiectasia and papulopustules
    c) Thick, greasy scales on the scalp and eyebrows
    d) Honey-colored crusted lesions around the mouth and nose
  3. Which of the following is a common trigger for rosacea flare-ups?
    a) Dairy products
    b) Spicy foods, alcohol, and sun exposure
    c) Gluten-containing foods
    d) High-protein diets
  4. What is the first-line treatment for papulopustular rosacea?
    a) Topical metronidazole
    b) High-dose oral corticosteroids
    c) Oral isotretinoin
    d) Antifungal creams
Reveal answers

Answers

  1. (b) Rosacea
    • The patient’s persistent facial redness, flushing, telangiectasia, and papulopustules without comedones is characteristic of rosacea, not acne vulgaris.
  2. (b) Persistent facial erythema with telangiectasia and papulopustules
    • Rosacea commonly presents with redness, visible small blood vessels (telangiectasia), and inflammatory lesions (papules and pustules), especially on the central face. Unlike acne, comedones (blackheads/whiteheads) are absent.
  3. (b) Spicy foods, alcohol, and sun exposure
    • Common rosacea triggers include hot beverages, alcohol, spicy foods, sun exposure, and emotional stress. Avoiding these can help manage symptoms.
  4. (a) Topical metronidazole
    • First-line treatment for papulopustular rosacea includes topical metronidazole, azelaic acid, or ivermectin. Oral doxycycline is used for more severe cases.