Pictorial case study

A 26-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 the face. It is more common in women, especially during the menopause. It is more apparent on people with fair skin.

Common triggers of rosacea include alcohol, caffeinated drinks, spicy foods, sunlight, wind, extremes of temperature, irritant topical products, menopausal flushing and drugs that cause vasodilation. Sometimes there are ocular manifestations such as blepharitis and conjunctivitis as well as oedema, burning or stinging.

This patient’s rosacea responded to oral tetracycline. She could have been treated with topical metronidazole. Isotretinoin is occasionally used in severe inflammatory forms of rosacea. More recently, lasers have been used to reduce erythema and telangiectasia.

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 to see an improvement.


Contributed by Dr Vasa Gnanapragasam, a GP in Sutton, Surrey

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us:

Just published

GP consultations up 400,000 in first three weeks of 2021 compared with last year

GP consultations up 400,000 in first three weeks of 2021 compared with last year

GPs have delivered around 400,000 more patient consultations in the first three full...

GPs vaccinate thousands of patients against COVID-19 in extraordinary settings

GPs vaccinate thousands of patients against COVID-19 in extraordinary settings

GPonline takes a look at some of the more interesting sites that have played host...

UK COVID-19 vaccination programme tracker

UK COVID-19 vaccination programme tracker

GPs across the UK are playing a leading role in the largest-ever NHS vaccination...

GPs to place orders for COVID-19 vaccine as NHS targets second dose at 12 weeks, says Stevens

GPs to place orders for COVID-19 vaccine as NHS targets second dose at 12 weeks, says Stevens

GP-led vaccination sites will be able to place orders for COVID-19 vaccine supplies...

RCGP and Marie Curie urge GPs to adopt end of life care standards for care homes

RCGP and Marie Curie urge GPs to adopt end of life care standards for care homes

Best practice standards to help GPs improve end of life care in care homes despite...

Thank your team for their inspirational work during the COVID-19 pandemic #myGPteam

Thank your team for their inspirational work during the COVID-19 pandemic #myGPteam

Never has teamwork in general practice been more important than during the COVID-19...