article · SAS Journal of Medicine
Granulomatous rosacea is an uncommon, chronic inflammatory variant of rosacea that exhibits specific histopathological features and frequently resists standard medical therapies. A documented case describes an eighty-year-old male who developed an eruption restricted to the right side of his face over three months, which followed several years of isolated unilateral erythema. A clinical examination identified purpuric papules alongside lupoid inflammatory nodules. Subsequent histopathological investigation confirmed a peri-follicular lymphoplasmacytic infiltrate containing non-caseating epithelioid granulomas as well as the presence of Demodex folliculorum mites. Following diagnosis, treatment comprising oral doxycycline paired with topical metronidazole resulted in partial clinical improvement for the patient. The findings demonstrate that unusual or one-sided facial skin conditions require thorough histopathological examination to achieve an accurate diagnosis and guide appropriate clinical care.
Atypical skin presentations on one side of the face can mimic other skin disorders, complicating clinical diagnosis and management. Documenting rare presentations of granulomatous rosacea helps clinicians recognise unusual symptoms, such as unilateral papules and nodules. It reinforces the necessity of using tissue biopsies to confirm diagnoses when standard conditions manifest in unexpected ways, ensuring patients receive targeted therapies.
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Granulomatous rosacea (GR) is a rare, chronic inflammatory variant of rosacea characterized by its distinct histopathology and resistance to standard therapies. We report a rare case of unilateral GR in an 80-year-old male. The patient presented with a three-month history of a right-sided facial eruption, following years of isolated unilateral erythema. Clinical examination revealed purpuric papules and lupoid inflammatory nodules. Histopathology confirmed a peri-follicular lymphoplasmacytic infiltrate with non-caseating epithelioid granulomas and Demodex folliculorum. The patient showed partial improvement with oral doxycycline and topical metronidazole. This case highlights the importance of histopathological evaluation in atypical, unilateral facial dermatoses.
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DOI: 10.36347/sasjm.2026.v12i09.005
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