Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obervation Letter
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF
Letter To Editor
2005:71:5;366-365
doi: 10.4103/0378-6323.16797
PMID: 16394471

Granulomatous rosacea mimicking eyelid dermatitis

C Ajith1 , Sunil Dogra1 , BD Radotra2 , Sanjeev Handa1
1 Departments of Dermatology, Venereology and Leprology, PGIMER, Chandigarh, India
2 Departments of Histopathology, PGIMER, Chandigarh, India

Correspondence Address:
Sanjeev Handa
Department of Dermatology, Venereology and Leprology, PGIMER, Chandigarh-160 012
India
How to cite this article:
Ajith C, Dogra S, Radotra B D, Handa S. Granulomatous rosacea mimicking eyelid dermatitis. Indian J Dermatol Venereol Leprol 2005;71:366-365
Copyright: (C)2005 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

Allergic contact dermatitis (ACD) due to topical medications for the eyes accounts for about 80% of cases of eyelid dermatitis.[1],[2] Sometimes, other periorbital dermatoses may be mistakenly labelled as ACD due to topical ophthalmic medications. Here, we report a patient of granulomatous rosacea with predominant periocular involvement, who was initially diagnosed as contact dermatitis secondary to topical eye medications.

A 60-year-old man presented with complaints of itchy eruptions around his eyes for the past 20 days. He correlated the onset of symptoms with the use of topical medications in his eyes prescribed by ophthalmologists for allergic conjunctivitis. His medications included sodium carboxymethyl cellulose, stabilized oxychlorocomplex, ketorolac tromethamine, benzalkonium chloride and polyvinyl alcohol.

On examination, both periorbital regions and the root of the nose were diffusely erythematous, edematous, studded with multiple erythematous papular lesions, and minimally scaly [Figure - 1]. The lesions extended on to the cheeks and up to the mid-forehead. A provisional diagnosis of ACD due to ophthalmic medications was made. Patch testing with the Indian standard series and his topical medications as antigens was negative. He was prescribed topical fluticasone dipropionate cream and was advised to avoid the ocular medications he was using. At follow-up after 2 weeks, the response was not satisfactory. Hence, a biopsy was done from the skin lesions. A H and E stained histopathological section showed a normal epidermis and dense collections of predominantly lymphocytic infiltrates surrounding the dilated blood vessels and hair follicles; features consistent with granulomatous rosacea [Figure - 2]. A final diagnosis of granulomatous rosacea was made. Topical fluticasone dipropionate was withheld and he was prescribed doxycycline 100 mg bid PO and topical metronidazole gel (0.75%) for local application twice daily. At follow-up after 8 weeks, there was almost complete clearance of the skin lesions [Figure - 3] and improvement of his eye symptoms. Subsequently, the initial diagnosis of allergic conjunctivitis was revised by the ophthalmologists to ocular rosacea.

Granulomatous rosacea is a dermatosis characterized by small, discrete, yellowish brown papules and pustules distributed across the center of the face and eyelids. The eyelids, lower part of the forehead, nasolabial folds, cheeks and perioral areas are frequent sites of involvement. [3] Histopathological examination reveals perivascular and perifollicular noncaseating epithelioid granulomas. The prevalence of ocular involvement in rosacea varies between 3% to 58% in different reports.[3],[4] Various ophthalmological manifestations that can occur in rosacea include blepharitis, conjunctivitis, iritis, iridocyclitis, hypopyoniritis, and keratitis. Other unusual presentations of rosacea include rosacea fulminans, persistent edema of rosacea and rosacea conglobata. Rosacea fulminans is considered an extreme form of the disease. There may be a rapid onset without any prior history of rosacea. In persistent edema of rosacea, a hard, non-pitting edema is found on the forehead, glabella, upper eyelids, nose or cheeks. Rosacea conglobata is characterized by a chronic, progressive course with haemorrhagic nodular abscesses and indurated plaques.[5]

The temporal correlation between the application of the ophthalmic topical medications and appearance of symptoms led to an initial misdiagnosis of ACD in our patient. Absence of prior symptoms suggestive of rosacea also contributed to this.

This report highlights the importance of considering rosacea as a diagnostic possibility in cases of eyelid dermatitis.

References
1.
Guin JD. Eyelid dermatitis: A report of 215 patients. Contact Dermatitis 2004;50:87-90.
[Google Scholar]
2.
Guin J. Eyelid dermatitis: a report of 203 cases. J Am Acad Dermatol 2002;47:755-65.
[Google Scholar]
3.
Patrinely JR, Font RL, Anderson RL. Granulomatous acne rosacea of the eyelids. Arch ophthalmol 1990;108:561-3.
[Google Scholar]
4.
Michel JL, Cabibel F. Frequency, severity and treatment of ocular rosacea during cutaneous rosacea. Ann Dermatol Venereol 2003;130:20-4.
[Google Scholar]
5.
Beuchner SA. Rosacea: An update. Dermatology 2005;210:100-8.
[Google Scholar]

Fulltext Views
166

PDF downloads
31
Show Sections