Granulomatous periorificial dermatitis: a variant of granulomatous rosacea in children?

Lupus Miliaris Disseminatus Faciei versus Granulomatous Rosacea: A Case Report

Lupus miliaris disseminatus faciei (LMDF) and granulomatous rosacea are 2 distinct inflammatory dermatoses with overlapping clinical features: reddish-yellow papular eruptions localized on the central face. Consequently, LMDF can easily be misdiagnosed as granulomatous rosacea or vice versa. Because delayed treatment in LMDF may increase chances of permanent scar formation, accurate diagnosis is important. We therefore analyzed published literature and case studies to organize the essential features differentiating LMDF from granulomatous rosacea. In addition, we report each case of LMDF and granulomatous rosacea for direct comparison.

Perioral dermatitis: diagnosis, proposed etiologies and management

Perioral dermatitis is a common cutaneous condition characterized by acneiform facial eruptions often with an eczematous appearance. A granulomatous subtype exists in addition to the classic variant. Whilst topical corticosteroids have been largely implicated in this condition, its etiology is not completely understood. Using the keywords "corticosteroids," "dermatology," "fusobacteria," "perioral dermatitis", and "periorificial dermatitis" we searched the databases PubMed, MEDLINE and EMBASE to find the relevant literature. Only articles in English were chosen. The level of evidence was evaluated and selected according to the highest level working our way downwards using the Oxford Centre of Evidence-Based Medicine 2011 guidance. This systematic review found the strongest evidence to support topical corticosteroid misuse as the principal causative factor in the pathogenesis of perioral dermatitis. In terms of treatment, further research is required to robustly investigate promising treatment options including tetracyclines, topical metronidazole, topical azelaic acid, adapalene gel and oral isotretinoin.

Granulomatous Periorificial Dermatitis in an Adult: A case report with review of literature

Granulomatous periorificial dermatitis (GPD) is a benign, self-limiting eruption that is considered a clinical variant of periorificial dermatitis, also known as perioral dermatitis. It presents primarily in prepubertal children as monomorphic scaly papules over perioral, paranasal and periorbital areas of the face with rare occurrence in adults. We report a 36-year-old Omani male patient who presented to the Dermatology Clinic at Bahla Polyclinic, Bahla, Oman, in 2018 with a papular eruption over his face for the previous six months. Based on clinical and histopathological findings the patient was diagnosed with GPD with sarcoid-like histology. He was treated effectively with oral doxycycline and topical metronidazole. This report provides a review of the literature on GPD and summarises all reported cases in adults to date.

Rosacea and its ocular manifestations

BACKGROUND

Rosacea is a chronic condition affecting the facial and ocular surface tissues. It is historically underdiagnosed and affects people of all ethnicities. The exact pathophysiology of rosacea is poorly understood. A variety of medical therapies are available to treat the various signs and symptoms of rosacea. Currently, there is no cure for the condition.

METHODS

This report is a literature review.

RESULTS

The clinical manifestations of rosacea are diverse, with periods of exacerbation and remission. Many short- and long-term treatments are available to alleviate the symptoms and effects of rosacea. Variations are common in the medications used, dosages, and durations of treatment. Current topical, oral, and surgical treatment options are presented and reviewed. As a chronic condition, rosacea treatment should be tailored toward individuals and adjusted over time.

CONCLUSIONS

Subtle presentations of rosacea may be overlooked by health care providers. When treating the condition, certain individuals may require both systemic and topical therapy to effectively control rosacea outbreaks. Eye care professionals need to be aware of the presence of rosacea to appropriately treat ocular surface disease that is not responding as expected to standard topical therapy. Severe facial and ocular surface damage caused by rosacea may need surgical intervention. Specific treatment protocols are elusive because of the diversity of the disease. Additional research is needed to find the exact cause of rosacea to more effectively manage the dermatologic and ocular manifestations of the disease and to find a cure.