A 45-year-old woman comes to the office for evaluation of reddened areas over her face. The symptoms began a few years ago but have been worse over the last 2 months. She works as a lifeguard and experiences facial redness and burning discomfort within 30-60 minutes of going outdoors. Using high-potency sun blocks and wide-brimmed hats has not led to any improvement. Her friends have commented that she has looked flushed after drinking a glass of wine. Medical history is notable for only seasonal allergies, for which she uses a fluticasone nasal spray and over-the-counter loratadine. On examination, there is erythema and small telangiectasias involving the nose, cheeks, and chin, as shown in the image. The oral pharynx is clear. The remainder of the patient's examination is normal. Which of the following is the most likely diagnosis?

Question

A 45-year-old woman comes to the office for evaluation of reddened areas over her face.  The symptoms began a few years ago but have been worse over the last 2 months.  She works as a lifeguard and experiences facial redness and burning discomfort within 30-60 minutes of going outdoors.  Using high-potency sun blocks and wide-brimmed hats has not led to any improvement.  Her friends have commented that she has looked flushed after drinking a glass of wine.  Medical history is notable for only seasonal allergies, for which she uses a fluticasone nasal spray and over-the-counter loratadine.  On examination, there is erythema and small telangiectasias involving the nose, cheeks, and chin, as shown in the image.  The oral pharynx is clear.  The remainder of the patient's examination is normal.  Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

11ec25c8_d388_d67d_bc81_75706202e6fe_MD0003_00 This patient's rash is consistent with erythematotelangiectatic rosacea, which typically occurs in fair-skinned individuals age >30. Other subtypes of rosacea include papulopustular, phymatous, and ocular. The etiology is unknown but may be due to a chronic inflammatory reaction to cutaneous microorganisms, ultraviolet light damage, or vasomotor dysfunction. papulopustular phymatous Patients with erythematotelangiectatic rosacea develop facial erythema in the nose and medial cheeks (including the nasolabial folds), facial flushing, telangiectasias, roughness or scaling, and burning discomfort. Symptoms are typically precipitated by hot drinks, alcohol, heat, emotion, and other causes of rapid body temperature changes. The episodes are usually intermittent but can progressively lead to permanently flushed skin. (Choice A) Carcinoid syndrome may also cause flushing and telangiectasias, but the flushing in rosacea tends to last much longer, whereas only 20-30 seconds of flushing (accompanied by hypotension and cyanosis in severe cases) is characteristic of carcinoid. Diarrhea is also often seen in carcinoid syndrome. (Choice B) Dermatomyositis can cause a rash involving sun-exposed areas but most commonly appears on the eyelids, forehead, neck, chest, and hands. The lesions have a dusky, purple hue. The skin lesions of dermatomyositis may occur prior to muscle symptoms, but most patients will have associated weakness. dusky, purple hue (Choice C) A photosensitivity drug reaction can cause acute erythema following brief sun exposure. However, symptoms are widespread, involving all sun-exposed areas rather than just the central face. It is most common with tetracyclines, diuretics, antiemetics, and antipsychotics but not with antihistamines or glucocorticoids. (Choice E) Seborrheic dermatitis causes a scaly, erythematous rash in skinfolds around the nose, eyebrows, ears, and scalp. Seborrheic dermatitis (Choice F) Systemic lupus erythematosus can cause a facial rash similar in distribution to rosacea; however, the rash is typically darker in color, spares the nasolabial folds, is not affected by alcohol intake, and is often accompanied by other manifestations of lupus (eg, constitutional symptoms, arthralgias, oral ulcers). Educational objective: Erythematotelangiectatic rosacea causes erythema involving the central face, facial flushing, telangiectasias, and burning discomfort. Symptoms are typically precipitated by hot drinks, alcohol, heat, emotion, and other causes of rapid body temperature changes. The episodes are usually intermittent but can lead to permanently flushed skin. References: Rosacea: part I. Introduction, categorization, histology, pathogenesis, and risk factors. (http://www.ncbi.nlm.nih.gov/pubmed/25890455)

A 45-Year-Old Woman Comes to the Office for Evaluation of Reddened