Lupoid or Granulomatous Rosacea

Lupoid or granulomatous rosacea is a special form of rosacea which along with the typical rosacea symptoms features monomorphic red papules and yellow-brown and nodules on the cheeks and periorificial areas.

Lupoid or granulomatous rosacea isn’t easy to treat and the only officially approved systemic treatment is tetracycline or doxycycline.

Isotretinoin (10-20 mg daily) can help recalcitrant lupoid or granulomatous rosacea.

Topical azelaic acid, metronidazole, ivermectin, benzoyl peroxide, brimonidine, pimecrolimus, dapsone, azithromycin, corticosteroids, systemic corticosteroids, and systemic minocycline can also help.

Another treatment is ALA–PDT (5‐Aminolevulinic acid‐photodynamic therapy): this is a study that was conducted where the patient received six sessions of PDT with δ-aminolaevulinic acid (ALA) at a concentration of 2% prepared in a base cream, applied with an occlusive dressing for 3 h, given at 2-weeks intervals. The irradiation source was a tungsten lamp with a spectrum emission ranging from 400 to 700 nm, peaking at 630 nm, with a total light dose that was 40 J/cm ²

Chromophore gel‐assisted phototherapy (CGAP) is another treatment: this is a study where the patient received twelve treatment sessions over 6 weeks involving the application of a 2 mm layer of the photoconverter chromophore gel (Kleresca) followed by irradiation with a multi‐LED lamp (415 nm and 447 nm). Significant improvement was observed in both the papulopustular and erythematotelangiectatic components of her rosacea. To date, there has been no relapse in her rosacea off all active treatment, at a time‐point 6 months after cessation of CGAP.