Faculty Bibliography

Persistent facial swelling may occur as a rare complication of rosacea. This finding has been referred to as lymphedematous rosacea, Morbihan's disease or persistent solid facial edema. A literature review for cases of lymphedematous rosacea revealed that the chronic inflammatory process that accompanies the disease contributes to an increase in the permeability of blood vessels. With time, the lymphatic drainage system becomes permanently impaired, leading to fluid accumulation in the affected skin. Herein, we report the case of a 58-year-old female with history of rosacea who developed bilateral periorbital swelling with associated erythema of the conjunctiva (ocular rosacea) over a 4 month period that only responded to oral corticosteroids. Biopsy revealed changes of lymphedematous rosacea.

Depigmented or hypopigmented macules and patches have been described in association to primary and metastatic melanoma. Primary melanoma presenting at the onset as a vitiliginous patch without histopathological evidence of regression seems to be a rare event. We report 2 patients with melanoma in situ that expressed clinically as vitiligo-like patches and review the possible immunologic mechanisms responsible for this unusual presentation.

Drug eruptions are common adverse reactions to drug therapy and are a frequent reason for consultation in clinical practice. Even though any medication can potentially cause an adverse cutaneous reaction, some drugs are implicated more commonly than others. Histologically, drugs can elicit a variety of inflammatory disease patterns in the skin and panniculus, no pattern being specific for a particular drug. The most common pattern elicited by systemically administered medications is the perivascular pattern. Psoriasiform or granulomatous patterns are rarely caused by medications. The usual histologic patterns of drug eruptions are discussed in this review using the basic patterns of inflammatory diseases. Clinicopathologic correlation is established for relevant patterns. However, the changes of drug-induced skin disease must be made considering clinical presentation, histopathological analysis, and course of the disease.

Rosacea is classified into four clinical subtypes, namely erythematotelangiectatic, papulopustular, phymatous, and ocular. There is also a granulomatous variant, which is recognized in the rosacea spectrum. The objective of this study is to take a closer look at the different histopathologic patterns and cellular compositions seen in granulomatous rosacea and their correlation to the clinical presentation. Facial biopsies from patients previously identified with a clinical diagnosis consistent with rosacea, and who demonstrated a granulomatous infiltrate upon histopathologic examination, were reviewed and the results were correlated to the clinical presentation. Four distinct histopathologic granulomatous patterns were identified, namely nodular, perifollicular, diffuse, and a combined perifollicular and nodular patterns. The clinical presentation varied greatly among patients and failed to correlate to the microscopic findings. The varied clinical features seen in our study favors the theory that granulomatous rosacea is not a clinical subtype of rosacea per se, but a distinct histological variant, which can be found in most of its clinical spectrum.