A case of rosacea-like dermatitis with atypical clinical features

A 24-year-old woman exhibited erythema around the mouth after use of a facial pack. Although she was treated with topical steroids and oral antihistamines at a local clinic, the symptoms did not improved. She consulted our department one month after the onset. Inltrative erythema was observed around the mouth, and there was no capillary dilation or pore-consistent papules. As we suspected contact dermatitis, cosmetics and topical preparations that had been used were discontinued, and a patch test was conducted. However, there was no positive reaction to any substance. Skin biopsy was performed. In the dermis, multiple granulomas without necrosis were detected. Under a diagnosis of perioral dermatitis, clindamycin ointment was prescribed and minocycline was orally administered, leading to the relief of exanthema. Even when clinically typical ndings, such as papules and capillary dilation, are absent, there is a possibility of rosacea-like dermatitis, as demonstrated in the present case. Therefore, it is important to positively consider skin biopsy for patients with refractory facial erythema.