Rosacea fulminans (pyoderma faciale): successful treatment of a 3‐year‐old girl with oral isotretinoin

A 3‐year‐old girl presented with several erythematous papules, pustules, cysts, and purulent discharging sinuses on the face. The lesions suddenly appeared on the cheeks 3 months previously and then rapidly extended to other areas of the face. She had been treated with a variety of topical and systemic antimicrobials (including erythromycin, cephalexin, dicloxacillin, and suIfamethoxazole‐trimethoprim) and topical corticosteroids with no effect. Examination revealed deep red erythema of facial skin with several papules, pustules, cysts, and draining sinuses on the cheeks, chin, perioral, and paranasal areas ( Fig. 1). No comedones or signs of hidradenitis suppurativa were observed. The child was otherwise in good health. She did not have a family history of severe acne vulgaris. 1Patient before treatment Routine laboratory tests, including complete blood count, blood chemistry, and urinalysis, were within normal limits. Bacterial cultures showed negative results. Her parents refused to give consent to perform a biopsy. She was initially treated with oral erythromycin, 250 mg four times daily, oral prednisolone, 7.5 mg (0.5 mg/kg body weight) daily, tapered to zero in 2 weeks, 0.025% fluocinolone acetonide cream, and warm compresses for 2 weeks with moderate improvement. Then oral isotretinoin, 10 mg (0.75 mg/kg body weight) daily, was instituted. The lesions showed marked improvement after 4 weeks and disappeared completely after 8 weeks, leaving only a few pitted scars ( Fig. 2). The treatment with isotretinoin was continued for a total of 24 weeks. She tolerated isotretinoin very well. She was followed for 1 year after completion of treatment with no relapse. 2Patient after 8 weeks of treatment with oral isotretinoin