Pictorial Case Study

The case 

A 52-year-old woman presented complaining of a red rash over her cheeks. The rash was burning and not itchy. Red papules were distributed over her cheeks, forehead and chin. There were a few pustules and she had nasal telangiectasia. She had noticed that heat, stress and sunlight made her face redder. What is the diagnosis, management and differential diagnoses?

Diagnosis and management

She has rosacea, a chronic condition that affects the skin, usually on the face. It is more common in women, especially during the menopause. It is more apparent in people with fair skin. This patient's rosacea responded to oral tetracycline. She could have been treated with topical metronidazole.

Possible different diagnoses

- Acne vulgaris.

- Seborrhoeic dermatitis.

- Systemic lupus erythematosus.

- Tuberous sclerosis.

- Perioral dermatitis.

Differential diagnosis

- Acne vulgaris

- Erythematous papules.

- Comedones, pustules and nodules may be seen.

- Neck, back, chest, shoulder and upper trunk can be affected.

- Anti-comedonal and anti-inflammatory agents should be used.

- Other treatment options: oral antibiotics, isotretinoin, antiandrogens.

- Advise that it may take months before one can see an improvement.

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