Explosive Rosacea?

The patient is a 33 year-old executive V.P. who presents with a 6 month history of dramatic facial eruption. He had acne as a teenager but has been clear for many years. His health is good and he takes no medication by mouth. He has never used topical corticosteroids for his face.


The examination shows erythematous papules and small cysts on forehead, cheeks and chin. There are a few papules on the back, but the chest is clear.






Diagnosis: Florid Rosaca

Plan:
I will place on prednisone 20 mg bid for a week or so and isotretinoin 0.25 mg per kg for a cple of weeks and then increase to 0.5 mg per kg fir a month or two. Slowly incvrease isotretinolin to 1 mg per kg over 8 weeks and anticipate a six moth course. The prednisone will be tapered over a month to 6 weeks to avoid a flare.

I could have started with doxycycline; but isotretinoin may be more definitive; I welcom your thoughts.

Thank you,

David