Rosacea fulminans is a rare inflammatory condition of the central face marked by the abrupt onset of erythematous coalescing papules, pustules, nodules, and draining sinuses. Due to infrequent reporting in the literature, the pathophysiology, classification, and nomenclature of this condition remain controversial. This comprehensive review evaluated a total of 135 cases of rosacea fulminans for clinical and histopathologic features and reported treatment strategies. Patients were 91% female with an average age of onset of 31.3 years. Only 19% of cases reported duration of symptoms longer than 3 months, and reports of recurrence were uncommon. A majority of patients had history of rosacea or flushing, and common triggers included hormonal shifts, emotional stress, and medications. Extrafacial or systemic involvement was rare. Though oral and topical antibiotics were frequently utilized to treat rosacea fulminans, there was a clear shift in reported treatments for rosacea fulminans following the introduction of isotretinoin use in 1987, marked by increased reliance on isotretinoin in addition to topical and systemic corticosteroids. Newer treatments were associated with superior improvement compared with antibiotic monotherapy, most notably dramatically reduced rates of scarring, though reduced rates of disease recurrence were not evident. Several patterns revealed through this review reinforce the classification of rosacea fulminans as a severe yet distinct variant of rosacea and highlight key distinguishing clinical features and treatment options for optimal management.
We have termed this entity midline anterior neck inclusion cyst. We believe it is a superficial developmental anomaly, probably a forme fruste of a midline fusion developmental defect, which has not to our knowledge, previously been described.
The patient was diagnosed with stage 2B MF and treated first with local radiation therapy and then with oral bexarotene, 75 mg, twice daily. After 4 months there was a complete response. Discussion | The occurrence of lipodermatosclerosis mimicking MF has been poorly described in the literature, with only 1 other case reported to our knowledge. 1 Several clinical morphological and textural features should be considered when evaluating similar lesions on the legs. Lipodermatosclerosis often presents as a localized, painful, indurated plaque with erythema and hyperpigmentation on the lower legs in a setting of venous insufficiency. The chronic form is said to resemble an "inverted champagne bottle." The typical presentation of MF is erythematous patches, plaques, or tumors with fine scale that favor sun protected areas. 2 Treatments for MF are based on the stage of the disease and include topical corticosteroids, topical nitrogen mustard, total skin electron beam therapy, oral retinoids, subcutaneous interferon alfa, histone deacetylase inhibitors, alemtuzumab, psoralen plus UV-A photochemotherapy (PUVA), and extracorporeal photopheresis. Lipodermatosclerosis is the result of chronic venous insufficiency. Both septal and lobular panniculitis as well as lipomembranous changes are seen on pathologic analysis. Mainstay treatments include compression, leg elevation, topical and/or intralesional corticosteroids, and anabolic steroids for recalcitrant disease. 3 Mycosis fungoides should be included in the differential diagnosis of any cutaneous patch or plaque that does not respond to first-and second-line treatments. A low threshold for obtaining biopsy should be the rule for any patient with a chronic, recalcitrant eruption.
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