Pustular eruption on face
Was there a connection between the patient’s rash and the fact that she’d recently begun taking Bikram yoga classes?
Tx hinges on oral, topical agents—as well as avoidance
Erythematotelangiectatic and papulopustular rosacea have common therapies that include a long list of oral and topical agents. Agents that are most commonly used include oral tetracyclines, topical sodium sulfacetamide, azelaic acid, and metronidazole.12
Another approach to treatment is called the “avoidance policy,” where triggers for blushing and facial erythema are identified and then avoided. One survey by the National Rosacea Society study found that 78% of patients felt that avoiding triggers was at least somewhat effective in controlling their rosacea.13
Time for a different form of yoga?
Because our patient developed papulopustular rosacea after taking Bikram yoga classes, we advised her to avoid this particular form of exercise because of the heat. We told her that she could, however, participate in other forms of yoga, as long as they were not done in a hot environment.
Due to the severity and severe inflammatory nature of her eruption, we started the patient on oral minocycline 100 mg twice daily, and 3 topical medicines including sodium sulfacetamide/sulfur 10%/5% wash, followed by azelaic acid 20% cream every night, and metronidazole 1% gel every morning to the affected areas.
Our patient’s condition responded to treatment. The erythema on her face improved and the number of papules and pustules declined.
CORRESPONDENCE: Heather W. Wickless, MD, MPH, Durango Dermatology, 523-B South Camino del Rio, Durango, CO 81303; hwickless@gmail.com
