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Rosacea Fulminans


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Rosacea Fulminans is a Rosacea Variant 
Sometimes referred as Pyoderma Faciale (PF) or Rosacea Conglobata [10] [11]

The RRDi classifies Rosacea Fulminans as a rosacea variant

See images of Rosacea Fulminans:

PMC images of Rosacea Fulminans

This variation is possibly the most extreme form of Rosacea. Rosacea Fulminans usually only occurs in women. It is characterized by its very rapid onset, often reaching the peak of severity within only days to weeks. Lesions form in the appearance of giant abscesses and multiple lesions and the resulting disfigurement is hideous. Even though Rosacea Fulminans is so disfiguring and debilitating, the prognosis is excellent. 

One patient was diagnosed with Rosacea fulminans associated with pegylated interferon alpha-2B and ribavirin therapy. [3]

Another report says that it is possible that it is "triggered by high-dose vitamins B6 and B12." [5]

Pyoderma Faciale (rosacea fulminans)

PF is a disorder characterized by a sudden fulminating onset of purulent nodulocystic lesions localized to the face with superficial or deep abscesses. It mainly affects women in their twenties. Some authors consider it a very severe form of acne while others interpret it as a severe form of rosacea.

Pyoderma Faciale is a rosacea variant.
6 DermIS images of Pyoderma Faciale

"Pyoderma faciale, also known as rosacea fulminans, is a conglobate, nodular disease that arises abruptly on the face." [7]

Rosacea conglobata

It occurs mainly in females. The disease is generally limited to the face and mimics the appearance of severe disfiguring acne. [10]

"Rosacea conglobata is a severe rosacea that shows a reaction which mimics acne conglobata with hemorrhagic nodular abscesses and indurated plaques." [11]

Click here for images of rosacea conglobata.


Typically the disease is treated with Accutane and steroids. Once Rosacea Fulminans is under control, it does not reoccur. [1]

One report says that Corticosteroids and isotretinoin are regarded as the two main therapeutic agents. [2]

Another case with Rosacea fulminans was diagnosed in a patient with Crohn's disease: a case report and review of the literature. The patient was treated and a "complete remission of the mucocutaneous symptoms was achieved with 2 months combination therapy with methylprednisolone, isotretinoin and dapsone." [4]

One report says two cases "responded to systemic treatment with corticosteroids, isotretinoin and metronidazole." [6]

"Oral tetracycline, erythromycin, dapsone and azithromycin have also been used successfully, the latter often employed in pregnancy where alternatives are limited. Topical therapies include compresses, topical steroids and topical antibiotics. While most reports cite isotretinoin as the most effective treatment..."[8]

"...a fifty-year-old male who presented with RF and was successfully treated with a combination of corticosteroids and isotretinoin." [9]

Doxycline [12]

Anecdotal Reports

Bizi reports taking 500 mg tetracycline twice a day, Domboro Astringent, and taking digestive/anti inflammatory enzymes. Posts #11 and 12 See all of Bizi's posts

Read Post #6, padie, whose daughter was diagnosed with rosacea fulminans, July 18, 2012

OMalleyJane (post no. 1) Shanz311 (post no. 11) krae88 (post no. 13) lanenga123  (post no. 19) jennat (post no. 21)

jennat wrote: 
"Diet consists solely of:
meat, fish, green leafy vegetables (kale, lettuce, chard, collards), mushrooms, cruciferous veggies. Absolutely nothing else. Tough at first, but after a year, I'm very happy to have found some relief!" see post #29

Received the following email from Michelle Doiron, Pyoderma Faciale sufferer, with a Master's Degree in Counseling Psychology who wants everyone to know what she did to conquer this variant of rosacea:
Received July 23, 2012:
<begin message>

I've got just a few minutes right now to send you a quick email, but I knew if I didn't more time would pass and it'd get put off like many other things that do in our lives.

After a handful of years of severe acne roseacea and pyoderma faciale...I can email photos at a later date...my face is almost completely clear. I got so sick of doctors being clueless and only recommending Acutane that I took matters into my own hands.

For ME I found it was connected to food and environmental sensitivities that trigger an allergic response in my body that only reacts on my face. An allergist put patches on my back and within hours my face was covered with itching, burning, pussfilled red pimples, beet red and on fire! When he removed the patches the next day and continued to follow up the day after that, my back was fine...NO sign of allergies, "but clearly it evoked a response on your face" he said, question was which one or combo out of the 40 or so allergens caused a response? I never found out...instead I started a nasal rinse (Neil Med) daily, and within 2 weeks my face cleared...and I also need to do the following to maintain a clear face...

Use a probiotic for women from a compounding pharmacy in Newton MA it's by Klaire Labs, use a prescription very low dose steroid cream, an antibacterial ointment used most often for patients with impetigo, Zinc oxide cream (I blend a bit of all 3 and apply to my face after washing my face with Dessert Essence gentle cleanser morning and night) AND I have to avoid all food triggers...right now on week 3 of The Clean diet by Alejandro Junger. IF I do all of this...I can have clear skin...my face still gets red and I still have broken blood vessels under the skin but it can be covered up when needed...ALSO for women with fair skin and sensitive skin like me...I found a great powder with NO chemicals at ALL...made mostly from arrowroot powder, it's pure white and super fine and looks wonderful...I also found an extremely gentle and organic facial cover up that works great!! I still get some cystic nodules here and there under my chin and the only thing that makes it go away unfortunately is Mometazone or Clobetazol both strong steroid ointments. I know research has said steroids make rosacea worse, but it really depends how it's used.

Please keep in contact as I also had lots of other health issues that are beginning to resolve as well. I've been on SSDI for 3 years and not worked due to the other issues (gut etc.) I feel that doctors have not found the true cause of what I term "reactive roseaca" as I feel there are others out there with this kind of roseacea that's not about eating hot foods or being too stressed (they DON"T bother me) and other more common triggers but more rare and strange and seemingly benign ones. And that a synergistic approach is needed. AND that it's really NOT always about stress but about an sub-allergic histamine response. And rosacea has a memory like Herpes, as it returns in the same locations, and often the rosacea pimples have to balance themselves out in a symetrical fashion...one pimple on right cheek, next another on left etc. I've been studying myself and this phenomenon for several years now...and the doc's are WAY off base as far as I'm concerned.

I'd be curious to know how many other Rosacea folks have unknown chronic sinusitis...I only found out during an MRI for neurological issues...also, the docs blew off the total sinus blockage and did nothing...there too I had to help myself...and the daily nasal rinse has helped that. If I eat something that I'm sensitive too, I'll get stuffed up and within hours pimples will show up on my face!! At least for me, I'm on to something!
Michelle Doiron
<end message>

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End Notes

[1] rosacea.derm.net.au

[2] Rosacea fulminans in pregnancy.
Lewis VJ, Holme SA, Wright A, Anstey AV.
Br J Dermatol. 2004 Oct;151(4):917-9.

[3] Rosacea fulminans associated with pegylated interferon alpha-2B and ribavirin therapy.
Jensen SL, Holmes R.
J Drugs Dermatol. 2003 Oct;2(5):554-6.

[4] Rosacea fulminans in a patient with Crohn's disease: a case report and review of the literature.
Romiti R, Jansen T, Heldwein W, Plewig G.
Acta Derm Venereol. 2000 Mar-Apr;80(2):127-9.

[5] Rosacea fulminans triggered by high-dose vitamins B6 and B12
T Jansen1, R Romiti, A Kreuter, P Altmeyer
Journal of the European Academy of Dermatology and Venereology, Volume 15, Issue 5, pages 484–485, September 2001

[6] Rosacea fulminans: report of two cases
[Article in Spanish]
Sanz-Motilva V, Martorell Calatayud A, Rivera R, Vanaclocha-Sebastián F.
Rev Med Chil. 2012 May;140(5):637-9. doi: 10.1590/S0034-98872012000500013.

[7]  Fitzpatrick's Dermatology in General Medicine. 7th Edition. New York: McGraw-Hill.
Wolff, K., Goldsmith, L., Katz, S., Gilchrest, B., Paller, A. S., & Leffell, D. (2008).

[8] Letters to the Editor, Rosacea fulminans
Indian Journal of Dermatology, Venereology and Leprology | May-June 2014 | Vol 80 | Issue 3 
Full Text

[9] Case Rep Dermatol Med. 2016;2016:5192689. Epub 2016 Sep 15.
Sudden Appearance of Indurated Erythematous Plaques on a Man's Face.
Carter A, Viswanathan K, Shulman K.

[10] Rosacea: An Introduction
patient notes on etiology, appearance, symptoms and treatment by Dr. J Prairie

[11] Hopefully we will figure out one day if it is a severe form of acne or a severe form of rosacea because Wikipedia says, "Rosacea conglobata is a severe rosacea that can mimic acne conglobata, with hemorrhagic nodular abscesses and indurated plaques." Wikipedia also says, "Pyoderma faciale (also known as "Rosacea fulminant") is a conglobata, nodular disease springing up abruptly on the face."  

[12] An Bras Dermatol. 2016 Sep-Oct;91(5 suppl 1):151-153. doi: 10.1590/abd1806-4841.20164943.
Rosacea fulminans: unusual clinical presentation of rosacea.
Coutinho JC1, Westphal DC2, Lobato LC1, Schettini AP3, Santos M3,4.



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