Gnatophyma - A rare form of rosacea
A 41-year old female patient presented growth and redness of the chin two years ago.\nDermatological examination showed well-defined infiltrated, erythematous, edematous,\nasymptomatic plaque on the chin and lower lip. The skin was thickened on the chin and\nthe rest of the face was unaltered ( and\n). The patient reported periods of\nexacerbation but was unable to relate it to psychological factors, stress and hot food\nor alcohol. She had been taking captopril, hydrochlorothiazide, metformin and fluoxetine\nfor five years. The initial diagnosis was contact dermatitis, so she was instructed to\nstop wearing makeup, creams, nickel jewelry and nail polish, associated with oral\ncorticosteroids for 30 days, but no improvement was noted. A skin biopsy of the chin\nshowed corneal plugs, dense lymphocytic perifollicle, periadnexal and perivascular\ninfiltrate in the dermis, sebaceous glands hyperplasia, hypertrophied hair follicles,\ndilated vessels and outline of giant cells ( and ). This histopathological result\nsuggested Syndrome of Mekelsson-Rosenthal, thus, in addition to oral corticosteroids, we\nintroduced intralesional steroids as part of the treatment, but there was no\nimprovement. Another possible diagnosis was rosacea, in its rare variant, gnatophyma.\nThe treatment prescribed was tetracycline 1 g/day, ivermectin 12 mg single dose and\nmetronidazole cream 1 %, with improvement of the clinical status (). Through clinical and histopathological correlation and a\nsatisfactory therapeutic response the diagnosis of gnatophyma was confirmed.