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1. Papulosquamous skin disease marked by a history of waxing and waning in severity and scaling in perinasal area manifested in this patient.
Diagnosis: Seborrheic dermatitis presenting as erythema with scaling on the perinasal and perioral area. Similar to rosacea, seborrheic dermatitis is a chronic and relapsing erythematous rash with well-demarcated erythematous patches, papules, or plaques; however, unlike rosacea, the distribution varies from minimal asymptomatic scaliness of the scalp to more widespread involvement (eg, scalp, ears, upper aspect of the trunk, intertriginous areas). Also, although macular erythema and scaling involving the perinasal area may be seen in either rosacea or seborrheic dermatitis, a greasy quality to the scales and involvement of other sites such as the scalp, retroauricular skin, and eyebrows suggest a diagnosis of seborrheic dermatitis
Read more about seborrheic dermatitis at The great mimickers of rosacea. Cutis. 2014;94(1):39-45.
For the next photograph, proceed to the next page >>
2. The patient had a painful, erythematous skin rash over the bridge of her nose, spreading to the malar area, eyelids, and forehead.
Diagnosis: Erysipelas is an acute superficial cellulitis with lymphatic involvement. It is characterized by the abrupt onset of a warm, erythematous rash with a sharply demarcated, indurated, elevated margin. There are no suppurative foci; sometimes, however, there are bullae or vesicles.
In facial “butterfly” erysipelas (which this patient had), the plaques may involve the eyelids, cheeks, nose, and forehead. Upon palpation, the skin is hot and tender. As the process develops, the color becomes a dark, fiery red and vesicles appear at the advancing border and over the surface. Associated regional lymphadenopathy may be present. There is no necrosis.1
Read more about erysipelas at Painful rash on face. J Fam Pract. 2010 August;59(8):459-462.
For the next photograph, proceed to the next page >>
3. Shortly after she started taking Bikram yoga classes, this 30-year-old patient developed inflammatory papules and pustules. Her symptoms worsened after each 1-hour session. On physical exam, there were erythematous, inflammatory papules and pustules concentrated on her forehead. No comedones were present.
Diagnosis: Rosacea, an inflammatory condition of the skin that typically affects the convex portions of the central face. This chronic cutaneous disorder usually starts after age 30 in both men and women, and is more prevalent in those with fairer skin.2 In fact, an epidemiologic study showed the prevalence to be as high as 10% in the Swedish population.3 The condition, which is not life threatening, can be controlled, although not cured. Its effect on appearance may have a negative impact on a patient’s quality of life.
Read more about Rosacea at Pustular eruption on face. J Fam Pract. 2010 July;59(7):399-401.
For the next photograph, proceed to the next page >>
4. Erythematous papules, papulovesicles, and plaques appeared on sun-exposed surfaces of the skin.
Diagnosis: Polymorphous light eruption (PMLE) manifesting as erythematous papules over the cheek and dorsal aspect of the nose. Similarities between PMLE and rosacea include exacerbation by sun exposure and a higher prevalence in fair-skinned individuals.4 Also, in both conditions erythematous papules appear on the face and may be pruritic and in some instances painful; however, unlike rosacea, which is chronic, PMLE tends to be intermittent and recurrent, typically occurring in the spring and early summer months.
Read more about PMLE at The great mimickers of rosacea. Cutis. 2014;94(1):39-45.
For the next photograph, proceed to the next page >>
5. This patient presented with isolated, grouped, and multiple erythematous to violaceous papules, plaques, or nodules, in an asymmetric distribution.
Diagnosis: B-cell neoplasms with skin involvement can present as primary cutaneous lymphomas or as secondary processes, including specific infiltrates of nodal or extranodal lymphoma or leukemia.5 B-cell lymphomas involving the skin have a distinct clinical appearance, presenting as isolated, grouped, or multiple erythematous to violaceous papules, plaques, or nodules, usually in an asymmetric distribution. B-cell lymphoproliferative diseases simulating rosacea are extremely rare.5 Nevertheless, B-cell lymphoma mimicking rhinophyma has been documented in the literature.5-11
Read more about B-cell neoplasms at The great mimickers of rosacea. Cutis. 2014;94(1):39-45.
Figures 1, 4, 5 reprinted with permission from Cutis. 2014;94(1):39-45; photographs for Figures 4 and 5 courtesy of Marc Silverstein, MD. Figure 2 reprinted with permission from J Fam Pract. 2010 August;59(8):459-462; photograph courtesy of Felix B. Chang, MD. Figure 3 reprinted courtesy of J Fam Pract. 2010 July;59(7):399-401; photograph courtesy of Nikki N. Kim, MD, Heather W. Wickless, MD, MPH.
REFERENCES
1. Chang F, Lopes A. Erysipelas. In: Domino FJ, ed. The 5-Minute Clinical Consult 2008. 16th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2008:448–449.
2. Gupta AK, Chaudhry MM. Rosacea and its management: an overview. J Eur Acad Dermatol Venereol. 2005;19:273-285.
3. Berg M, Liden S. An epidemiological study of rosacea. Acta Derm Venereol. 1989;69:419-423.
4. Tutrone WD. Polymorphic light eruption. Dermatol Ther. 2003;16:28-39.
5. Barzilai A, Feuerman H, Quaglino P, et al. Cutaneous B-cell neoplasms mimicking granulomatous rosacea or rhinophyma. Arch Dermatol. 2012;148:824-831.
6. Moulonguet I, Ghnassia M, Molina T, et al. Miliarial-type perifollicular B-cell pseudolymphoma (lymphocytoma cutis): a misleading eruption in two women. J Cutan Pathol. 2012;39:1016-1021.
7. Soon CW, Pincus LB, Ai WZ, et al. Acneiform presentation of primary cutaneous follicle center lymphoma. J Am Acad Dermatol. 2011;65:887-889.
8. Rosmaninho A, Alves R, Lima M, et al. Red nose: primary cutaneous marginal zone B-cell lymphoma. Leuk Res.2010;34:682-684.
9. Ogden S, Coulson IH. B-cell lymphoma mimicking rhinophyma. Clin Exp Dermatol. 2008;33:213-214.
10. Seward JL, Malone JC, Callen JP. Rhinophymalike swelling in an 86-year-old woman. Primary cutaneous B-cell lymphoma of the nose. Arch Dermatol. 2004;140:751-756.
11. Colvin JH, Lamerson CL, Cualing H, et al. Cutaneous lymphoplasmacytoid lymphoma (immunocytoma) with Waldenström’s macroglobulinemia mimicking rosacea. J Am Acad Dermatol. 2003;49:1159-1162.
1. Papulosquamous skin disease marked by a history of waxing and waning in severity and scaling in perinasal area manifested in this patient.
Diagnosis: Seborrheic dermatitis presenting as erythema with scaling on the perinasal and perioral area. Similar to rosacea, seborrheic dermatitis is a chronic and relapsing erythematous rash with well-demarcated erythematous patches, papules, or plaques; however, unlike rosacea, the distribution varies from minimal asymptomatic scaliness of the scalp to more widespread involvement (eg, scalp, ears, upper aspect of the trunk, intertriginous areas). Also, although macular erythema and scaling involving the perinasal area may be seen in either rosacea or seborrheic dermatitis, a greasy quality to the scales and involvement of other sites such as the scalp, retroauricular skin, and eyebrows suggest a diagnosis of seborrheic dermatitis
Read more about seborrheic dermatitis at The great mimickers of rosacea. Cutis. 2014;94(1):39-45.
For the next photograph, proceed to the next page >>
2. The patient had a painful, erythematous skin rash over the bridge of her nose, spreading to the malar area, eyelids, and forehead.
Diagnosis: Erysipelas is an acute superficial cellulitis with lymphatic involvement. It is characterized by the abrupt onset of a warm, erythematous rash with a sharply demarcated, indurated, elevated margin. There are no suppurative foci; sometimes, however, there are bullae or vesicles.
In facial “butterfly” erysipelas (which this patient had), the plaques may involve the eyelids, cheeks, nose, and forehead. Upon palpation, the skin is hot and tender. As the process develops, the color becomes a dark, fiery red and vesicles appear at the advancing border and over the surface. Associated regional lymphadenopathy may be present. There is no necrosis.1
Read more about erysipelas at Painful rash on face. J Fam Pract. 2010 August;59(8):459-462.
For the next photograph, proceed to the next page >>
3. Shortly after she started taking Bikram yoga classes, this 30-year-old patient developed inflammatory papules and pustules. Her symptoms worsened after each 1-hour session. On physical exam, there were erythematous, inflammatory papules and pustules concentrated on her forehead. No comedones were present.
Diagnosis: Rosacea, an inflammatory condition of the skin that typically affects the convex portions of the central face. This chronic cutaneous disorder usually starts after age 30 in both men and women, and is more prevalent in those with fairer skin.2 In fact, an epidemiologic study showed the prevalence to be as high as 10% in the Swedish population.3 The condition, which is not life threatening, can be controlled, although not cured. Its effect on appearance may have a negative impact on a patient’s quality of life.
Read more about Rosacea at Pustular eruption on face. J Fam Pract. 2010 July;59(7):399-401.
For the next photograph, proceed to the next page >>
4. Erythematous papules, papulovesicles, and plaques appeared on sun-exposed surfaces of the skin.
Diagnosis: Polymorphous light eruption (PMLE) manifesting as erythematous papules over the cheek and dorsal aspect of the nose. Similarities between PMLE and rosacea include exacerbation by sun exposure and a higher prevalence in fair-skinned individuals.4 Also, in both conditions erythematous papules appear on the face and may be pruritic and in some instances painful; however, unlike rosacea, which is chronic, PMLE tends to be intermittent and recurrent, typically occurring in the spring and early summer months.
Read more about PMLE at The great mimickers of rosacea. Cutis. 2014;94(1):39-45.
For the next photograph, proceed to the next page >>
5. This patient presented with isolated, grouped, and multiple erythematous to violaceous papules, plaques, or nodules, in an asymmetric distribution.
Diagnosis: B-cell neoplasms with skin involvement can present as primary cutaneous lymphomas or as secondary processes, including specific infiltrates of nodal or extranodal lymphoma or leukemia.5 B-cell lymphomas involving the skin have a distinct clinical appearance, presenting as isolated, grouped, or multiple erythematous to violaceous papules, plaques, or nodules, usually in an asymmetric distribution. B-cell lymphoproliferative diseases simulating rosacea are extremely rare.5 Nevertheless, B-cell lymphoma mimicking rhinophyma has been documented in the literature.5-11
Read more about B-cell neoplasms at The great mimickers of rosacea. Cutis. 2014;94(1):39-45.
Figures 1, 4, 5 reprinted with permission from Cutis. 2014;94(1):39-45; photographs for Figures 4 and 5 courtesy of Marc Silverstein, MD. Figure 2 reprinted with permission from J Fam Pract. 2010 August;59(8):459-462; photograph courtesy of Felix B. Chang, MD. Figure 3 reprinted courtesy of J Fam Pract. 2010 July;59(7):399-401; photograph courtesy of Nikki N. Kim, MD, Heather W. Wickless, MD, MPH.
REFERENCES
1. Chang F, Lopes A. Erysipelas. In: Domino FJ, ed. The 5-Minute Clinical Consult 2008. 16th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2008:448–449.
2. Gupta AK, Chaudhry MM. Rosacea and its management: an overview. J Eur Acad Dermatol Venereol. 2005;19:273-285.
3. Berg M, Liden S. An epidemiological study of rosacea. Acta Derm Venereol. 1989;69:419-423.
4. Tutrone WD. Polymorphic light eruption. Dermatol Ther. 2003;16:28-39.
5. Barzilai A, Feuerman H, Quaglino P, et al. Cutaneous B-cell neoplasms mimicking granulomatous rosacea or rhinophyma. Arch Dermatol. 2012;148:824-831.
6. Moulonguet I, Ghnassia M, Molina T, et al. Miliarial-type perifollicular B-cell pseudolymphoma (lymphocytoma cutis): a misleading eruption in two women. J Cutan Pathol. 2012;39:1016-1021.
7. Soon CW, Pincus LB, Ai WZ, et al. Acneiform presentation of primary cutaneous follicle center lymphoma. J Am Acad Dermatol. 2011;65:887-889.
8. Rosmaninho A, Alves R, Lima M, et al. Red nose: primary cutaneous marginal zone B-cell lymphoma. Leuk Res.2010;34:682-684.
9. Ogden S, Coulson IH. B-cell lymphoma mimicking rhinophyma. Clin Exp Dermatol. 2008;33:213-214.
10. Seward JL, Malone JC, Callen JP. Rhinophymalike swelling in an 86-year-old woman. Primary cutaneous B-cell lymphoma of the nose. Arch Dermatol. 2004;140:751-756.
11. Colvin JH, Lamerson CL, Cualing H, et al. Cutaneous lymphoplasmacytoid lymphoma (immunocytoma) with Waldenström’s macroglobulinemia mimicking rosacea. J Am Acad Dermatol. 2003;49:1159-1162.
1. Papulosquamous skin disease marked by a history of waxing and waning in severity and scaling in perinasal area manifested in this patient.
Diagnosis: Seborrheic dermatitis presenting as erythema with scaling on the perinasal and perioral area. Similar to rosacea, seborrheic dermatitis is a chronic and relapsing erythematous rash with well-demarcated erythematous patches, papules, or plaques; however, unlike rosacea, the distribution varies from minimal asymptomatic scaliness of the scalp to more widespread involvement (eg, scalp, ears, upper aspect of the trunk, intertriginous areas). Also, although macular erythema and scaling involving the perinasal area may be seen in either rosacea or seborrheic dermatitis, a greasy quality to the scales and involvement of other sites such as the scalp, retroauricular skin, and eyebrows suggest a diagnosis of seborrheic dermatitis
Read more about seborrheic dermatitis at The great mimickers of rosacea. Cutis. 2014;94(1):39-45.
For the next photograph, proceed to the next page >>
2. The patient had a painful, erythematous skin rash over the bridge of her nose, spreading to the malar area, eyelids, and forehead.
Diagnosis: Erysipelas is an acute superficial cellulitis with lymphatic involvement. It is characterized by the abrupt onset of a warm, erythematous rash with a sharply demarcated, indurated, elevated margin. There are no suppurative foci; sometimes, however, there are bullae or vesicles.
In facial “butterfly” erysipelas (which this patient had), the plaques may involve the eyelids, cheeks, nose, and forehead. Upon palpation, the skin is hot and tender. As the process develops, the color becomes a dark, fiery red and vesicles appear at the advancing border and over the surface. Associated regional lymphadenopathy may be present. There is no necrosis.1
Read more about erysipelas at Painful rash on face. J Fam Pract. 2010 August;59(8):459-462.
For the next photograph, proceed to the next page >>
3. Shortly after she started taking Bikram yoga classes, this 30-year-old patient developed inflammatory papules and pustules. Her symptoms worsened after each 1-hour session. On physical exam, there were erythematous, inflammatory papules and pustules concentrated on her forehead. No comedones were present.
Diagnosis: Rosacea, an inflammatory condition of the skin that typically affects the convex portions of the central face. This chronic cutaneous disorder usually starts after age 30 in both men and women, and is more prevalent in those with fairer skin.2 In fact, an epidemiologic study showed the prevalence to be as high as 10% in the Swedish population.3 The condition, which is not life threatening, can be controlled, although not cured. Its effect on appearance may have a negative impact on a patient’s quality of life.
Read more about Rosacea at Pustular eruption on face. J Fam Pract. 2010 July;59(7):399-401.
For the next photograph, proceed to the next page >>
4. Erythematous papules, papulovesicles, and plaques appeared on sun-exposed surfaces of the skin.
Diagnosis: Polymorphous light eruption (PMLE) manifesting as erythematous papules over the cheek and dorsal aspect of the nose. Similarities between PMLE and rosacea include exacerbation by sun exposure and a higher prevalence in fair-skinned individuals.4 Also, in both conditions erythematous papules appear on the face and may be pruritic and in some instances painful; however, unlike rosacea, which is chronic, PMLE tends to be intermittent and recurrent, typically occurring in the spring and early summer months.
Read more about PMLE at The great mimickers of rosacea. Cutis. 2014;94(1):39-45.
For the next photograph, proceed to the next page >>
5. This patient presented with isolated, grouped, and multiple erythematous to violaceous papules, plaques, or nodules, in an asymmetric distribution.
Diagnosis: B-cell neoplasms with skin involvement can present as primary cutaneous lymphomas or as secondary processes, including specific infiltrates of nodal or extranodal lymphoma or leukemia.5 B-cell lymphomas involving the skin have a distinct clinical appearance, presenting as isolated, grouped, or multiple erythematous to violaceous papules, plaques, or nodules, usually in an asymmetric distribution. B-cell lymphoproliferative diseases simulating rosacea are extremely rare.5 Nevertheless, B-cell lymphoma mimicking rhinophyma has been documented in the literature.5-11
Read more about B-cell neoplasms at The great mimickers of rosacea. Cutis. 2014;94(1):39-45.
Figures 1, 4, 5 reprinted with permission from Cutis. 2014;94(1):39-45; photographs for Figures 4 and 5 courtesy of Marc Silverstein, MD. Figure 2 reprinted with permission from J Fam Pract. 2010 August;59(8):459-462; photograph courtesy of Felix B. Chang, MD. Figure 3 reprinted courtesy of J Fam Pract. 2010 July;59(7):399-401; photograph courtesy of Nikki N. Kim, MD, Heather W. Wickless, MD, MPH.
REFERENCES
1. Chang F, Lopes A. Erysipelas. In: Domino FJ, ed. The 5-Minute Clinical Consult 2008. 16th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2008:448–449.
2. Gupta AK, Chaudhry MM. Rosacea and its management: an overview. J Eur Acad Dermatol Venereol. 2005;19:273-285.
3. Berg M, Liden S. An epidemiological study of rosacea. Acta Derm Venereol. 1989;69:419-423.
4. Tutrone WD. Polymorphic light eruption. Dermatol Ther. 2003;16:28-39.
5. Barzilai A, Feuerman H, Quaglino P, et al. Cutaneous B-cell neoplasms mimicking granulomatous rosacea or rhinophyma. Arch Dermatol. 2012;148:824-831.
6. Moulonguet I, Ghnassia M, Molina T, et al. Miliarial-type perifollicular B-cell pseudolymphoma (lymphocytoma cutis): a misleading eruption in two women. J Cutan Pathol. 2012;39:1016-1021.
7. Soon CW, Pincus LB, Ai WZ, et al. Acneiform presentation of primary cutaneous follicle center lymphoma. J Am Acad Dermatol. 2011;65:887-889.
8. Rosmaninho A, Alves R, Lima M, et al. Red nose: primary cutaneous marginal zone B-cell lymphoma. Leuk Res.2010;34:682-684.
9. Ogden S, Coulson IH. B-cell lymphoma mimicking rhinophyma. Clin Exp Dermatol. 2008;33:213-214.
10. Seward JL, Malone JC, Callen JP. Rhinophymalike swelling in an 86-year-old woman. Primary cutaneous B-cell lymphoma of the nose. Arch Dermatol. 2004;140:751-756.
11. Colvin JH, Lamerson CL, Cualing H, et al. Cutaneous lymphoplasmacytoid lymphoma (immunocytoma) with Waldenström’s macroglobulinemia mimicking rosacea. J Am Acad Dermatol. 2003;49:1159-1162.