My Co Tran, Kate DeAmbrosis
Rosacea fulminans, previously known as pyoderma faciale, is a rare severe centrofacial dermatosis characterised by the rapid eruption of inflammatory papules, pustules, nodules, and cysts, telangiectasia, and phymatous skin changes. Rosacea fulminans predominantly affects young women in their 20s and 30s, often in the absence of systemic symptoms, comedomes and extrafacial involvement.1 Circumoral and circumocular sparing is a common clinical feature. Though newer understanding of the complex interplay between genetic and environmental factors, the immune system, and neurogenic inflammation in rosacea has advanced significantly in the recent decade; classification of rosacea fulminans as a variant of rosacea remains controversial and its underlying aetiopathogenesis elusive.2_x000D_
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We report two cases of a brother and sister with rosacea fulminans, highlighting the need for further research into genetics predisposing factors and mechanism of disease to better guide treatment and to avoid complications such as scarring, disfigurement, and psychological distress.3_x000D_
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In these cases, management required consideration of pregnancy and breastfeeding which precluded the traditional use of high dose systemic steroids and isotretinoin in our female patient. Their younger siblings reportedly are beginning to have similar onset of symptoms. Clarifying the genetics and epigenetics of rosacea fulminans in future could provide a more targeted therapeutic armament._x000D_
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