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Vassileva S, Tanev I, Drenovska K. Rosacea: The eyes have it. Clin Dermatol 2023; 41:528-536. [PMID: 37591470 DOI: 10.1016/j.clindermatol.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
Rosacea is a chronic inflammatory dermatosis typically affecting the facial skin but also the eyes. With its chronic course with fluctuating episodes of flashing, redness, papulopustules, and nodules it poses a severe psychologic burden to the affected individuals. In addition to the facial changes, more than half of the patients have ocular involvement ranging from blepharitis and conjunctival hyperemia to more severe ophthalmic damage, and even blindness. Clinically, the ocular involvement in rosacea includes meibomian gland dysfunction with relapsing hordeola and chalazia, diffuse hyperemic conjunctivitis, photophobia, episcleritis, or kerato-conjunctivitis, and in rare cases, corneal ulcers. These are mainly observed in adult patients but can also occur in children. Depending on the degree of cutaneous or ocular findings, patients with rosacea may present first to the dermatologist or to the ophthalmologist. Both specialists should be aware of the potential oculocutaneous involvement. Any ocular complaints expressed by the patient in the setting of a dermatologist's office should be referred promptly for an ophthalmologic examination. Conversely, signs suggestive of rosacea in the eye should lead the ophthalmologist to consider underlying skin disease. A timely interdisciplinary collaboration is paramount for the earlier diagnosis and treatment, thus preventing permanent eye impairment in this chronic dermatosis.
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Affiliation(s)
- Snejina Vassileva
- Department of Dermatology and Venereology, Medical University - Sofia, Sofia, Bulgaria.
| | - Ivan Tanev
- ZRENIE Private Eye Clinic, Sofia, Bulgaria
| | - Kossara Drenovska
- Department of Dermatology and Venereology, Medical University - Sofia, Sofia, Bulgaria
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Abstract
PURPOSE To describe 10 patients with Morbihan syndrome, a rare condition characterized by the slow appearance of erythema and solid edema on the upper portion of the face, and review the literature. METHODS Retrospective case series and review. RESULTS The majority of patients were male (80%), and the mean age at presentation was 67 years (range, 48-88 years); 60% had asymmetrical disease (affecting mainly the right side). All subjects underwent a lid biopsy to support the diagnosis of Morbihan syndrome, which showed features of inflammation and vascular dysfunction, highly suggestive of a rosacea histological picture complicated by chronic lymphoedema. A range of medical and surgical treatment were used with variable success. The most effective ones included oral isotretinoin, intralesional triamcinolone injections, and debulking surgery. CONCLUSIONS Morbihan syndrome is a rare and chronic condition. It can be difficult to treat and may require a range of interventions.
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Welsch K, Schaller M. Combination of ultra-low-dose isotretinoin and antihistamines in treating Morbihan disease - a new long-term approach with excellent results and a minimum of side effects. J DERMATOL TREAT 2020; 32:941-944. [PMID: 32022617 DOI: 10.1080/09546634.2020.1721417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Morbihan disease is characterized by erythema and solid edema in the two upper thirds of the face. Underlying factors are an imbalance in lymphatic drainage, chronic inflammation, and mast cells leading to fibrosis. Treatment options known thus far have led to unsatisfactory results and have often been associated with a greater risk of side effects; even invasive options have been applied. This study presents four patients treated with a combination of ultra-low-dose isotretinoin and antihistamines for a mean duration of 14 months. While no side effects other than dryness of the lips were noted, a significant reduction of the erythema and edema could be observed in all patients. Specialists evaluated the treatment's success by photodocumentation and measured a 91.5% alleviation of erythema, and 85% reduction of edema, respectively. Based on these results, this new regimen in the therapeutic approach toward Morbihan disease is suggested due to its anti-inflammatory features and low risk of side effects.
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Affiliation(s)
- Katharina Welsch
- Department of Dermatology, University of Tuebingen, Tuebingen, Germany
| | - Martin Schaller
- Department of Dermatology, University of Tuebingen, Tuebingen, Germany
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Abstract
Morbihan syndrome is a rare entity causing woody induration of the face. There are numerous case reports of bilateral Morbihan syndrome. We present a case of a 46-year-old man with right infra-orbital cheek swelling and symptoms of rosacea who had histology consistent with granulomatous rosacea following debulking surgery. His clinical presentation and investigation findings support a diagnosis of rosacea causing unilateral Morbihan syndrome.
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Affiliation(s)
- Saliya Weeraman
- Dermatology, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - Andrew Birnie
- Dermatology, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
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Morbihan Disease Treatment: Two Case Reports and a Systematic Literature Review. Ophthalmic Plast Reconstr Surg 2019; 35:126-132. [DOI: 10.1097/iop.0000000000001229] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Cabral F, Lubbe LC, Nóbrega MM, Obadia DL, Souto R, Gripp AC. Morbihan disease: a therapeutic challenge. An Bras Dermatol 2018; 92:847-850. [PMID: 29364446 PMCID: PMC5786404 DOI: 10.1590/abd1806-4841.20174485] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 06/10/2015] [Indexed: 01/02/2023] Open
Abstract
Morbihan disease is a rare condition characterized by chronic and persistent erythematous solid edema localized on the face. It is believed to be a complication of rosacea and may occur at any stage of the disease. Features of this condition include variable therapeutic response and great refractoriness. We report a case of a 61-year-old man with rosacea history diagnosed with Morbihan disease, who showed excellent therapeutic response with the combination of deflazacort and oral isotretinoin but developed recurrence after corticosteroid discontinuation. We believe that in severe cases of lymphedema of the face this combination is effective and corticosteroid suspension should be done slowly and gradually.
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Affiliation(s)
- Fernanda Cabral
- Dermatology Service at Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro (HUPE-UERJ) - Rio de Janeiro (RJ), Brazil
| | - Lara Caroline Lubbe
- Dermatology Service at Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro (HUPE-UERJ) - Rio de Janeiro (RJ), Brazil
| | - Monisa Martins Nóbrega
- Dermatology Service at Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro (HUPE-UERJ) - Rio de Janeiro (RJ), Brazil
| | - Daniel Lago Obadia
- Dermatology Service at Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro (HUPE-UERJ) - Rio de Janeiro (RJ), Brazil.,Dermatopathology Service at Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro (HUPE-UERJ) - Rio de Janeiro (RJ), Brazil
| | - Roberto Souto
- Dermatology Service at Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro (HUPE-UERJ) - Rio de Janeiro (RJ), Brazil
| | - Alexandre Carlos Gripp
- Dermatology Service at Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro (HUPE-UERJ) - Rio de Janeiro (RJ), Brazil
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Carruth BP, Meyer DR, Wladis EJ, Bradley EA, Al-Rohil R, Jones DM, Bartley GB. Extreme Eyelid Lymphedema Associated With Rosacea (Morbihan Disease): Case Series, Literature Review, and Therapeutic Considerations. Ophthalmic Plast Reconstr Surg 2017; 33:S34-S38. [PMID: 26505236 DOI: 10.1097/iop.0000000000000581] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE To describe severe lymphedema of the eyelids, known as Morbihan disease, a previously characterized but infrequently reported and poorly understood entity related to rosacea that features solid mid-facial and eyelid lymphedema. METHODS Retrospective chart review, histopathologic and immunohistochemical analysis, and pertinent literature consideration. RESULTS Five cases of Morbihan disease were identified. Histopathologic examination revealed pleomorphic perivascular and perilymphatic inflammation with profound lymphangiectasis and lymph stasis, thus suggesting elements of both rosacea and localized, chronic lymphedema. Multiple therapeutic interventions were performed including systemic anti-inflammatory therapy, surgical debulking, and corticosteroid injection. CONCLUSIONS Extreme eyelid edema associated with characteristic skin changes and histopathologic findings represents an entity known as Morbihan disease which is rare and difficult to treat. While multiple modalities have been employed with variable results, future therapeutic considerations may include the use of targeted biologic agents.
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Affiliation(s)
- Bryant P Carruth
- *Ophthalmic Plastic Surgery, Lions Eye Institute, Albany Medical College, Slingerlands, New York; †Department of Ophthalmology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota; and ‡Department of Pathology, Albany Medical College, Albany, New York, U.S.A
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8
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Eber AE, Mlacker S, Verne S, Griffith R, Ledon J, Perper M, Nouri K, Cho-Vega JH. Morbihan disease complicated by dermatosis neglecta: An unique presentation. J Cutan Pathol 2017; 44:470-473. [DOI: 10.1111/cup.12902] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 01/04/2017] [Accepted: 01/11/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Ariel E. Eber
- Department of Dermatology and Cutaneous Surgery; Miller School of Medicine,University of Miami; Miami Florida
| | - Stephanie Mlacker
- Department of Dermatology and Cutaneous Surgery; Miller School of Medicine,University of Miami; Miami Florida
| | - Sebastian Verne
- Department of Dermatology and Cutaneous Surgery; Miller School of Medicine,University of Miami; Miami Florida
| | - Robert Griffith
- Department of Dermatology and Cutaneous Surgery; Miller School of Medicine,University of Miami; Miami Florida
| | - Jennifer Ledon
- Department of Dermatology and Cutaneous Surgery; Miller School of Medicine,University of Miami; Miami Florida
| | - Marina Perper
- Department of Dermatology and Cutaneous Surgery; Miller School of Medicine,University of Miami; Miami Florida
| | - Keyvan Nouri
- Department of Dermatology and Cutaneous Surgery; Miller School of Medicine,University of Miami; Miami Florida
| | - Jeong Hee Cho-Vega
- Dermatopathology Division, Department of Pathology; Sylvester Comprehensive Cancer Center; Miami Florida
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Abstract
Rosacea is a common and chronic inflammatory cutaneous disease with unknown etiology. The pathophysiology of rosacea is still poorly understood. Epidemiological studies indicate a genetic component, but a rosacea gene has not been detected yet. Recent molecular studies propose that an altered innate immune response is involved in the pathogenesis of the rosacea disease. Signs of rosacea are indicated by the presence of characteristic facial or ocular inflammation involving both the vascular and tissue stroma. A wide range of drug options is available for the treatment of rosacea, including several topical ones (metronidazole, antibiotics, azelaic acid, benzoyl peroxide, sulfacetamide/sulfur, retinoids) and oral ones (mainly tetracyclines, metronidazole, macrolides, isotretinoin). This review highlights the recent clinical and pathophysiological developments concerning rosacea.
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Okhovat JP, Armstrong AW. Updates in Rosacea: Epidemiology, Risk Factors, and Management Strategies. CURRENT DERMATOLOGY REPORTS 2014. [DOI: 10.1007/s13671-014-0070-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Ranu H, Lee J, Hee TH. Therapeutic hotline: Successful treatment of Morbihan's disease with oral prednisolone and doxycycline. Dermatol Ther 2011; 23:682-5. [PMID: 21054712 DOI: 10.1111/j.1529-8019.2010.01373.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Persistent facial swelling can occur as a rare complication of rosacea. This finding is referred to as lymphedematous rosacea or Morbihan's disease. We report a case of a 45-year-old male with no previous history of rosacea who developed bilateral periorbital swelling associated with facial erythema and edema that responded to a combination of oral corticosteroids and doxycycline. Biopsy revealed changes of granulomatous rosacea.
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Affiliation(s)
- Harneet Ranu
- National Skin Center, 1 Mandalay Road, 308205, Singapore.
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Abstract
PURPOSE To evaluate the clinical features, management and outcomes of treatment of chronic lymphedema of the eyelid in a tertiary referral setting. DESIGN Retrospective case series. PARTICIPANTS 15 patients referred to the authors with unilateral or bilateral eyelid swelling of greater than 3 months duration. MAIN OUTCOME MEASURES Clinical features, patient management, response to treatment. RESULTS Chronic eyelid lymphedema was associated with acne rosacea in 9 patients, radiotherapy in 1 patient, trauma in 1 patient and post-vitrectomy silicone oil leak in 1 patient. In the remaining 4 patients no associated condition or factor was identified. Surgical debulking was performed in 9 cases with improvement in all cases and no complications. CONCLUSION Chronic eyelid lymphedema is a rare condition most commonly associated with rosacea. In our experience, surgical resection of involved subcutaneous tissue was helpful.
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Affiliation(s)
- Rajeev Chalasani
- Ophthalmology Registrar, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
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Bae YI, Yun SJ, Lee JB, Kim SJ, Won YH, Lee SC. Clinical evaluation of 168 korean patients with rosacea: the sun exposure correlates with the erythematotelangiectatic subtype. Ann Dermatol 2009; 21:243-9. [PMID: 20523797 DOI: 10.5021/ad.2009.21.3.243] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Accepted: 12/15/2008] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Although rosacea is a chronic cutaneous inflammatory disorder that's commonly seen in adults, the etiology and pathogenesis of the illness remain unclear. A well established diagnostic classification and grading system may play a critical role in performing research and it would serve as a diagnostic reference in the clinical field. OBJECTIVE We sought to classify the patients with the new standard classification and grading system and we wanted determine the peculiar features and relationships of each subtype. We also analyzed the relationships between the degree of sun exposure and each subtype. METHODS We reviewed the medical records and clinical photos of 168 patients who were diagnosed with rosacea from 2002 to 2007 at our hospital. The standard classification and grading system suggested by the National Rosacea Society (NRS) Expert Committee was adopted to evaluate each patient's subtype and the severity. RESULTS The male:female ratio was 1:2.29. The mean age at the time of diagnosis was 47.8 years. The mean duration of disease was 3.5 years. Sun exposure and hot baths/exercise were the two most common precipitating factors, while the majority of patients did not have any specific factor that relieved their symptoms. According to the NRS classification and grading system, the patients were classified into four subtypes. One hundred sixty two (96.4%) patients were diagnosed with the erythematotelangiectatic subtype irrespective of severity. Eighty five (50.6%) patients had the papulopustular subtype and 24 (14.3%) patients had ocular rosacea. Eight (4.8%) patients displayed mild phymatous change. The degree of sun exposure had significant correlation with the development and severity of the erythematotelangiectatic subtype (p<0.05), while it had no correlation with the papulopustular, ocular and phymatous subtypes. CONCLUSION Although the erythematotelangiectatic subtype was the most common subtype of rosacea, many patients also had other subtypes of rosacea simultaneously. Based on our results, we proved that ocular rosacea is an extension of the clinical spectrum of erythematotelangiectatic rosacea. In addition, the results of our study particularly suggest that sun exposure has a different influence on each subtype of rosacea.
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Affiliation(s)
- You In Bae
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
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15
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Lu S, Tran TA, Jones DM, Meyer DR, Ross JS, Fisher HA, Carlson JA. Localized lymphedema (elephantiasis): a case series and review of the literature. J Cutan Pathol 2009; 36:1-20. [DOI: 10.1111/j.1600-0560.2008.00990.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Nagasaka T, Koyama T, Matsumura K, Chen KR. Persistent lymphoedema in Morbihan disease: formation of perilymphatic epithelioid cell granulomas as a possible pathogenesis. Clin Exp Dermatol 2008; 33:764-7. [PMID: 18627384 DOI: 10.1111/j.1365-2230.2008.02892.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Morbihan disease is a rare complication of rosacea, characterized by persistent lymphoedema on the upper half of the face, occurring during the chronic clinical course of rosacea. This refractory condition has been also designated as 'rosacea lymphoedema' and 'solid persistent facial oedema of rosacea'. We report a patient with Morbihan disease showing persistent lymphoedema on the upper half of the face accompanied by unique histological findings of striking dermal dilated lymphatics and damage of the lymphatics at the site of the adjacent epithelioid cell granulomas, with histiocytes bulging into the lymphatic lumen. The marked epithelioid cell granulomas forming around dermal lymphatic vessels with subsequent lymphatic damage and luminal obstruction by histiocytic infiltration may account for the development of lymphoedema in this patient.
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Affiliation(s)
- T Nagasaka
- Department of Dermatology, Saiseikai Central Hospital, Tokyo, Japan.
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Abstract
PURPOSE To describe the clinical presentation and treatment of ocular rosacea in children, an often unrecognized entity. METHODS Retrospective chart review of 20 patients (age, 22 months to 17 years) who presented during childhood with corneal pathology, lid margin disease, and skin changes consistent with ocular rosacea. All patients were evaluated by the Cornea/External Disease Division of a tertiary-care facility, Bascom Palmer Eye Institute, Miami, FL, between 1990 and 2003. RESULTS Sixty percent of patients improved after treatment with systemic erythromycin or doxycycline and topical low-dose steroid preparations. Ten percent of patients experienced no change in symptoms with treatment, and 30% of patients had incomplete follow-up to determine success of treatment. The patients maintained remission for up to 4 years after a slow taper of systemic treatment. The mean length of follow-up was 19.6 months (range, 0-9 years). CONCLUSIONS Early recognition and treatment of ocular rosacea in children may improve patient outcome by limiting progression of corneal pathology, including scarring and vascularization.
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Abstract
Atopic dermatitis and rosacea are chronic diseases that have both dermatologic and ocular manifestations. The occurrence of ocular disease is often proportionately higher than that of dermatologic disease. Even if the skin abnormalities appear well controlled, these patients require ophthalmic evaluation as well. Optimal management usually requires a team approach that includes internists, dermatologists, and ophthalmologists. Both disorders are characterized by acute exacerbations and require maintenance therapy for control. Exacerbations need aggressive treatment to limit ocular signs and symptoms and to reduce ocular inflammation that can lead to permanent visual loss. Topical corticosteroid use, although at times needed, should be minimized for both disorders. Future research will continue to emphasize the use of steroid-sparing and immune-modulating agents that have the potential to provide long-lasting anti-inflammatory control with a more favorable side-effect profile.
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Affiliation(s)
- Andrew S Eiseman
- Eye Clinic, Walter Reed Army Medical Center, Washington, DC 20307, USA.
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Abstract
Rosacea is a common chronic cutaneous disorder of unknown etiology which occurs most commonly in middle-aged individuals. Cutaneous manifestations include transient or persistent facial erythema, telangiectasia, edema, papules and pustules that are usually confined to the central portion of the face. The National Rosacea Society's Expert Committee on the Classification and Staging of Rosacea identified four subtypes of rosacea: erythematotelangiectatic, papulopustular, phymatous and ocular. Recently, a standard grading system for assessing gradations of the severity of rosacea has been reported. Little is known about the cause of rosacea. Genetic, environmental, vascular, inflammatory factors and microorganisms such as Demodex folliculorum and Helicobacter pylori have been considered. Topical metronidazole and azelaic acid have been demonstrated to be effective treatments for rosacea. Severer or persistent cases may be treated with oral metronidazole, tetracyclines or isotretinoin.
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Crawford GH, Pelle MT, James WD. Rosacea: I. Etiology, pathogenesis, and subtype classification. J Am Acad Dermatol 2005; 51:327-41; quiz 342-4. [PMID: 15337973 DOI: 10.1016/j.jaad.2004.03.030] [Citation(s) in RCA: 306] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Rosacea is one of the most common conditions dermatologists treat. Rosacea is most often characterized by transient or persistent central facial erythema, visible blood vessels, and often papules and pustules. Based on patterns of physical findings, rosacea can be classified into 4 broad subtypes: erythematotelangiectatic, papulopustular, phymatous, and ocular. The cause of rosacea remains somewhat of a mystery. Several hypotheses have been documented in the literature and include potential roles for vascular abnormalities, dermal matrix degeneration, environmental factors, and microorganisms such as Demodex folliculorum and Helicobacter pylori. This article reviews the current literature on rosacea with emphasis placed on the new classification system and the main pathogenic theories. Learning objective At the conclusion of this learning activity, participants should be acquainted with rosacea's defining characteristics, the new subtype classification system, and the main theories on pathogenesis.
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Affiliation(s)
- Glen H Crawford
- Department of Dermatology, University of Pennsylvania Medical Center, USA
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Abstract
Rosacea is a common skin disease that frequently involves the eye. Although the pathogenesis of the disease remains undefined, recent findings suggest that an altered inflammatory response plays an important role in both cutaneous and ocular rosacea. Ocular manifestations include lid and ocular surface alterations. Chronic inflammation can lead to corneal vascularization, which may compromise vision. Treatment of ocular rosacea is aimed at preventing irritation of the ocular surface (e.g., lubricants, lid hygiene) and controlling inflammation with topical and systemic anti-inflammatory drugs. Systemic tetracyclines are the mainstay of treatment. These drugs act multifactorially by decreasing bacterial flora and the expression of matrix metalloproteinases, altering meibum secretion, inhibiting the production of bacterial lipases, and providing an immunomodulatory effect.
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Affiliation(s)
- Lenio S Alvarenga
- Department of Ophthalmology, University of California, Davis, California, USA
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Abstract
PURPOSE To present a patient with rosacea lymphoedema of one upper eyelid resulting in unilateral complete ptosis. METHODS A 51-year-old white man presented with a 12-month history of progressive painless swelling of the left upper eyelid. An incisional biopsy of the upper eyelid was performed. RESULTS The biopsy showed dermal oedema with lymphangiectasia and telangiectasia, accompanied by a mild to moderate mixed chronic inflammatory infiltrate of lymphocytes, histiocytes, plasma cells and rare eosinophils. Stains for fungi and mycobacteria were negative. The lack of lichenoid reaction, dermal mucin or lip swelling indicated a lymphoedematous manifestation of rosacea. The patient was treated with minocycline and prednisolone with no effect. CONCLUSION Rosacea lymphoedema involving the eyelid, as in our case, is a rare complication and can present diagnostic and therapeutic challenges to the ophthalmologist.
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Affiliation(s)
- Tze Foon Lai
- Oculoplastic and Orbital Unit, Department of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Abstract
We describe a male patient with rosacea who had a 2-year history of persistent bilateral oedema of the eyelids, leading to an elephantoid condition with blepharoptosis. An upper eyelid blepharoplasty was performed, but swelling progressively recurred over a few months. Based on the case history, clinical appearance and histological findings, rosaceous lymphoedema was considered to be the diagnosis. The latter is a bilateral, solid oedema of the mid-third of the face, regarded as a rare complication of rosacea. It is thought to occur as a result of chronic inflammation and lymphatic stasis, but its exact aethiopathogenesis remains elusive. Predominant eyelid involvement, causing severe visual impairment as in our patient, is unique.
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Affiliation(s)
- A V Marzano
- Institute of Dermatological Sciences of the University of Milan and IRCCS Ospedale Maggiore of Milan, Milan, Italy
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Abelson MB, Pratt S, Mussoline JE, Townsend D. One-visit, randomized, placebo-controlled, conjunctival allergen challenge study of scanning and imaging technology for objective quantification of eyelid swelling in the allergic reaction with contralateral use of olopatadine and artificial tears. Clin Ther 2003; 25:2070-84. [PMID: 12946551 DOI: 10.1016/s0149-2918(03)80205-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The eyelids are more susceptible than other tissues to swelling, acute inflammation, and resultant long-term damage. However, no precise, objective means of measuring eyelid swelling in the clinical setting has been developed. OBJECTIVES The aims of this study were to assess the novel use of scanning and imaging technology for quantifying eyelid swelling and to use positive and negative controls to assess this new method for potential use in future clinical studies of eyelid swelling and pharmaceutical agents' effects on it. METHODS This was a 1-visit, single-center, prospective, randomized, double-masked, placebo-controlled study using the conjunctival allergen challenge (CAC). After baseline examinations and eyelid scanning, medication was instilled as follows: olopatadine hydrochloride 0.1% ophthalmic solution in 1 eye and placebo in the other. An allergen solution to which patients had a history of reaction was instilled in each eye 15 minutes after instillation of medication. Evaluations were performed for itching (3, 5, and 7 minutes after CAC), redness and chemosis (10, 15, 20, and 30 minutes), subjective eyelid evaluation (15 and 30 minutes), and 3-dimensional (3D) objective eyelid scan (15 and 30 minutes). RESULTS One hundred seven patients were randomized. Fifty-six patients (35 women, 21 men; mean age, 44.7 years) were evaluable for efficacy. Results of the objective and subjective evaluations of eyelid swelling were consistent, indicating significantly less eyelid swelling in olopatadine-treated eyes than in those that received placebo (objective evaluation, P < 0.001 at 15 minutes, P < 0.017 at 30 minutes; subjective evaluation, P < 0.001 at 15 and 30 minutes). Patients rated eyelid swelling in the placebo eye as 2.31 times and 2.40 times greater than that in the olopatadine-treated eye at 15 and 30 minutes, respectively. However, the digitally scanned eyelid swelling was calculated to be 5.65 times and 1.76 times greater in the placebo eye at the same respective time points. Reduction of ocular chemosis was observed in olopatadine-treated eyes at all time points (P < 0.001). CONCLUSIONS In this study, eyelid swelling was quantifiably measured with 3D imaging technology. In this model, the standard antiallergy medication olopatadine, used as a positive control, significantly modulated eyelid swelling when used prophylactically. A negative control, artificial tears, did not significantly affect the allergic eyelid-swelling reaction. These results concurred with subjective grading but offered a more precise assessment of eyelid swelling.
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Wilkin J, Dahl M, Detmar M, Drake L, Feinstein A, Odom R, Powell F. Standard classification of rosacea: Report of the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea. J Am Acad Dermatol 2002; 46:584-7. [PMID: 11907512 DOI: 10.1067/mjd.2002.120625] [Citation(s) in RCA: 482] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Jonathan Wilkin
- Division of Dermatologic and Dental Drug Products, Food and Drug Administration, Rockville, MD, USA
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Cuevas T. Identifying and treating rosacea. Nurse Pract 2001; 26:13-5, 19-23; quiz 24-5. [PMID: 11416937 DOI: 10.1097/00006205-200106000-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Rosacea is a chronic, cutaneous vascular disorder that affects approximately 13 million Americans. The facial disorder, which often affects people of Northern European descent, is characterized by four stages. Although rosacea is not curable, early recognition and treatment can prevent progression to permanent disfigurement or blindness. Pharmacologic therapy, patient education, and symptom management can provide symptom control and remission.
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Affiliation(s)
- T Cuevas
- Hancock Medical Center, Bay St. Louis, Miss., USA
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Bernardini FP, Kersten RC, Khouri LM, Moin M, Kulwin DR, Mutasim DF. Chronic eyelid lymphedema and acne rosacea. Report of two cases. Ophthalmology 2000; 107:2220-3. [PMID: 11097600 DOI: 10.1016/s0161-6420(00)00429-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The authors describe the clinical findings and surgical treatment of two patients affected by chronic eyelid lymphedema associated with facial acne rosacea. DESIGN Two interventional case reports. METHODS AND INTERVENTION: The clinical diagnosis of acne rosacea was based on the physical examination and confirmed by the histopathologic findings obtained from biopsy of the involved tissue. Surgical treatment was required to address the disfiguring chronic eyelid lymphedema and to correct the resultant mechanical lower eyelid ectropion in both patients. RESULTS Surgical debulking of the affected soft tissue resulted in very satisfactory cosmetic and functional improvement in both patients. CONCLUSIONS To our knowledge, this is the first series of cases of chronic eyelid lymphedema secondary to acne rosacea reported in the ophthalmic literature. Six similar cases have been described previously in the dermatologic literature; all of which had been treated medically without satisfactory results. Surgical debulking of the involved eyelids should be considered in patients affected by persistent symptomatic rosacea lymphedema.
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Affiliation(s)
- F P Bernardini
- Ophthalmology Clinic, S. Martino Hospital, University of Genova School of Medicine, Genova, Italy
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Jansen T, Romiti R, Messer G, Stücker M, Altmeyer P. Superior vena cava syndrome presenting as persistent erythematous oedema of the face. Clin Exp Dermatol 2000; 25:198-200. [PMID: 10844493 DOI: 10.1046/j.1365-2230.2000.00613.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The superior vena cava syndrome occurs when extrinsic compression or intraluminal occlusion impedes blood flow through this vessel. Detecting the characteristic cutaneous features can lead to an early diagnosis of this condition. We report a 73-year-old patient with a 4-year-history of erythematous oedema of the face. The underlying cause was a large retrosternal goitre obstructing the superior vena cava. Subtotal thyroidectomy led to dramatic improvement of all dermatologic symptoms.
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Affiliation(s)
- T Jansen
- Department of Dermatology and Allergology, Ruhr-University Bochum and Ludwig-Maximilians-University of Munich, Germany
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