Red nose with pustules | Figure 1
Red nose with pustules
Woman in her 50's, no relevant priors except for multiple CVRF.
Lesions on her nose for 1 year, slowly increasing in size.
Started on doxycycline for 2 months with no improvement. A biopsy was done, which revealed granulomas with a marked lymphocytic infiltrate, in a probable context of granulomatous rosacea. PCR for M. Tuberculosis was negative.
We started her on isotretinoin 20 mg/day, with only mild improvement (first photo is after 2 months of isotretinoin, second photo when she presented to our department).
Any suggestions?