Unexpected Complications: A Case of Rosacea Fulminans in Pregnancy

Abstract

Rosacea fulminans (RF) is a rare facial dermatosis that typically affects women with a fulminating course that presents with superficial and deep-seated papules, pustules, and nodules, as well as an intense reddish or cyanotic erythema localized to the face. Although the etiology of RF remains unknown, immunologic, hormonal, and vascular factors have been implicated. We describe a case of a 32-year-old pregnant woman presenting with RF. Presentation in a pregnant patient is not commonly reported and requires special consideration to manage.

Facial rash with exuberant crusting in pregnancy

“…1 Patients present suddenly with tender coalescing inflamed pustules, nodules, draining sinuses, and cysts/abscesses on the central face. 2 Our patient presented with numerous pustules, with the additional and unique feature of thick, confluent, yellow-gray crusting. To our knowledge, prior reports of patients with crusted papulopustules have not shown such exuberant facial crusting.…”

“…Possibly, her underlying systemic lupus erythematosus (SLE), stress and altered immunity during pregnancy, and mask wearing promoted vascular hyperreactivity and inflammation predisposing to development of pyoderma faciale. 2 Pyoderma faciale can mimic infectious and inflammatory processes. In our patient with SLE on immunosuppression, the differential diagnosis included infections such as impetigo, an acute lupus flare, pyostomatitis vegetans, or an atypical facial presentation of amicrobial pustulosis associated with autoimmune disease (APAD).…”

A case of rosacea fulminans during pregnancy

“…Including our case, 27 cases of RF during pregnancy have been reported to date [1][2][3][4][5][6][7][8][9] (Table 1): Median age at diagnosis was 31 years (range: 26-33) and 54% of the patients developed RF during the first trimester. Of those whose medical history was investigated, 58% had a history of acne or rosacea and 45% of the patients had RF during their first pregnancy.…”