Diagnosis and Treatment of Rosacea Fulminans: A Comprehensive Review.

Journal Article (Journal Article;Review)

Rosacea fulminans is a rare inflammatory condition of the central face marked by the abrupt onset of erythematous coalescing papules, pustules, nodules, and draining sinuses. Due to infrequent reporting in the literature, the pathophysiology, classification, and nomenclature of this condition remain controversial. This comprehensive review evaluated a total of 135 cases of rosacea fulminans for clinical and histopathologic features and reported treatment strategies. Patients were 91% female with an average age of onset of 31.3 years. Only 19% of cases reported duration of symptoms longer than 3 months, and reports of recurrence were uncommon. A majority of patients had history of rosacea or flushing, and common triggers included hormonal shifts, emotional stress, and medications. Extrafacial or systemic involvement was rare. Though oral and topical antibiotics were frequently utilized to treat rosacea fulminans, there was a clear shift in reported treatments for rosacea fulminans following the introduction of isotretinoin use in 1987, marked by increased reliance on isotretinoin in addition to topical and systemic corticosteroids. Newer treatments were associated with superior improvement compared with antibiotic monotherapy, most notably dramatically reduced rates of scarring, though reduced rates of disease recurrence were not evident. Several patterns revealed through this review reinforce the classification of rosacea fulminans as a severe yet distinct variant of rosacea and highlight key distinguishing clinical features and treatment options for optimal management.

Full Text

Duke Authors

Cited Authors

  • Walsh, RK; Endicott, AA; Shinkai, K

Published Date

  • February 2018

Published In

Volume / Issue

  • 19 / 1

Start / End Page

  • 79 - 86

PubMed ID

  • 28656562

Electronic International Standard Serial Number (EISSN)

  • 1179-1888

Digital Object Identifier (DOI)

  • 10.1007/s40257-017-0310-0


  • eng

Conference Location

  • New Zealand