A case of granulomatous rosacea successfully treated with pimecrolimus cream

Abstract

A 43-year-old male attended with lesions on his face that had been present for 3 months. On dermatological examination, multiple papules and pustules were seen on the forehead, nose, bilateral cheeks and lower eyelids. The patient used systemic clindamycin and doxycycline and topical benzoyl peroxide therapies, but the lesions did not regress. Routine laboratory tests were normal. Histopathological examination of the lesions confirmed the diagnosis of granulomatous rosacea. Pimecrolimus cream 1% was applied to the lesions. The regression of lesions began in the first month and complete improvement was observed at the end of the fourth month of therapy. Rosacea is a chronic, inflammatory skin disorder characterized by remissions and relapses. Although it is known that the disease is a treatable disorder, it may be resistant to standard therapies and there is a need for new therapy alternatives in some patients. We present a case of granulomatous rosacea successfully treated with pimecrolimus cream and believe that pimecrolimus may be a good alternative for the treatment of granulomatous rosacea.

Granulomatous Rosacea and Periorificial Dermatitis

“…23 There are 2 case reports of the use of pimecrolimus 1% cream applied to lesions twice a day with good efficacy. 34,35 One patient used pimecrolimus 1% topical cream combined with sun block twice a day resulting in complete resolution of lesions after 4 months of therapy. 35 The other patient responded well to pimecrolimus 1% cream after failing a 45-day course of topical metronidazole and oral doxycyline.…”

“…34,35 One patient used pimecrolimus 1% topical cream combined with sun block twice a day resulting in complete resolution of lesions after 4 months of therapy. 35 The other patient responded well to pimecrolimus 1% cream after failing a 45-day course of topical metronidazole and oral doxycyline. 34 There was no evidence of relapse after stopping the medication.…”

Pimecrolimus (Topical): Rosacea

“…4,5 In contrast, data from noncontrolled settings suggest a benefit associated with pimecrolimus therapy, including one study that demonstrated comparable efficacy to topical metronidazole 1% cream. 6–9 National guidelines and international consensus statements on rosacea management recognize the varying levels of evidence associated with the use of this topical agent and state that further evidence is needed to provide conclusive support for use. 10,11…”

“…Isolated case reports have documented the effectiveness of pimecrolimus 1% cream in adult patients with refractory rosacea. 8,9…”

Guías clínicas para el tratamiento de la rosácea

“…En una serie de casos se encontró disminución del eritema, de las lesiones inflamatorias y del edema, sin cambios en las telangiectasias, en rosácea pápulo-pustular y eri-temato-telangiectásica 89 . En dos reportes de casos se evaluó su efectividad en la rosácea granulomatosa, obteniéndose excelente resultado, sin recaídas a los seis meses de suspender el tratamiento 90,91 .…”