History: 77 y/o WF with a history of rosacea who has recently experienced increased redness and pustules). She was treated with minocycline for 10 years but it was discontinued one year ago due to hyperpigmentation. She was then started on clarithromycin, but her symptoms worsened. She also tried topicort and clinique with no relief. Patient states that her face has been painful and irritated with progressive worsening to the point that it interferes with her daily activities.
Past Medical History: rosacea, diabetes, salivary gland tumor s/p resection.
Medications: metformin, aspirin, clarithromycin
Physical Exam: numerous erythematous papules, pustules, and scaling on her face, neck, and chest (Figs. 1,2) in addition to bluish/gray patches on her face.
Click here for the diagnosis