Photo Rounds

Worsening rash on face

A 34-year-old woman sought care for a rash on her face that had worsened over the past 5 years. The patient said that since she was a teenager, she flushed easily. She also noted that she’d developed many “pimples” in the 6 months following the birth of her daughter. Sun worsened the rash, but many sunscreens irritated her skin. The patient said her mother’s face had a similar appearance. On exam, the family physician (FP) noted papules, pustules, and telangiectasias on her face.

What's your diagnosis?


This patient had rosacea, an inflammatory condition of the face and eyes that mostly affects adults (women more often than men). Patients’ cheeks and noses become reddened, and they develop telangiectasias and papulopustular eruptions. Rosacea is common in fair-skinned people of Celtic and northern European heritage.

In this case, the FP counseled the patient about the diagnosis of rosacea and the factors that can worsen it, including exposure to the sun, alcohol, hot beverages, and spicy foods. The FP started the patient on doxycycline 100 mg twice daily with the intent to taper it to once daily in the future. In addition, he wrote a prescription for metronidazole gel to be used once daily.

The patient agreed to wear a hat and stay out of the sun during the middle of the day. She also promised to look for a sunscreen she could tolerate. A follow-up appointment was arranged for the following month.

Photo and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Usatine R. Rosacea. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:659-664.

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