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JAMA Dermatology Clinicopathological Challenge
March 25, 2020

Facial Erythema in an Elderly Man

Author Affiliations
  • 1Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
  • 2Department of Dermatology, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
  • 3Dermatopathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
JAMA Dermatol. 2020;156(5):587-588. doi:10.1001/jamadermatol.2020.0123

A man in his 80s with a pacemaker; a history of congestive heart failure, coronary artery disease, atrial fibrillation, transient ischemic attack, and Parkinson disease; and dependence in all activities of daily living presented to the dermatology department with a 4-month history of new-onset persistent facial eruption. He denied a history of facial flushing. The patient was initially treated for rosacea at an outside hospital with topical 1% metronidazole cream for 1 month without improvement and developed acute facial purpura after 1 day of treatment with oral doxycycline, which was discontinued. Because of the eruption’s rapid onset and violaceous appearance, as well as empirical treatment failure, the patient was referred for further evaluation. On examination, the patient had asymmetric, centrofacial, erythematous-violaceous indurated telangiectatic and ecchymotic plaques over a phymatous background (Figure, A). A series of punch biopsies were performed (Figure, B-D).

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    1 Comment for this article
    Nice case
    JEFFREY CALLEN, MD | University of Louisville
    I have been involved in the care of several patients with neoplastic disease that mimicked forms of rosacea. You might be interested in these references:

    French NH, Williams TJ, Callen JP: Rhinophyma-like swelling of the nose due to squamous cell carcinoma of the lung metastatic to the nasal tip. Eur J Dermatol 1995; 5: 131-4

    Seward JL, Malone JC, Callen JP. Rhinophyma-like swelling in an 86-year-old woman. Primary cutaneous B-cell lymphoma of the nose. Arch Dermatol. 2004 Jun;140(6):751-6.
    CONFLICT OF INTEREST: None Reported
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