Pyoderma Faciale - Causes, Symptoms, Diagnosis, and Treatment

Introduction

In 1940 by O'Leary and Kierland, rosacea fulminans was originally called pyoderma faciale and considered an acne conglobata variant. However, in 1992 Plewig et al. suggested that pyoderma faciale is a severe variant of rosacea, detailing the disease and termed pyoderma faciale rosacea fulminans. Pyoderma faciale is primarily observed in younger women and is typical in pregnancy. Pyoderma faciale presents as unattractive and painful big red bulges, nodules, bumps, and sores in especially red areas. The exact mechanisms for the incidence of pyoderma faciale are unknown, but pyoderma faciale is suggested to be the extreme form of rosacea.

What Is Pyoderma Faciale?

Pyoderma faciale, also called 'rosacea fulminans,' is an uncommon skin condition in young adult women. It can resemble the severe form of acne and rosacea. Pyoderma faciale begins suddenly and lasts more than a year. Pyoderma faciale is not associated with an individual with oily skin, and it does not arise from comedones. Pyoderma faciale is confined to the face and is rarely present in males. The symptoms of pyoderma faciale are present on the cheeks, chin, and forehead. In addition, the lesions of pyoderma faciale may leave scars. In severe cases, inflammatory symptoms are present. Internal symptoms are absent in pyoderma faciale. The symptoms of pyoderma faciale are managed with antibiotics and Isotretinoin. Systemic steroids are suggested in the severe form of pyoderma faciale. Based on the clinical features and history of symptoms, the diagnosis of pyoderma faciale is made.

What Are the Causes of Pyoderma Faciale?

The exact etiology of the pyoderma faciale is unknown. However, most cases are between pregnancy and individuals using oral contraceptives. Some other conditions related to pyoderma faciale are erythema nodosum, Helicobacter pylori infection, and liver and thyroid disease. In addition, it is observed that the pyoderma faciale are predisposed to some factors. Some predisposing factors of pyoderma faciale include Pegylated interferon alpha-2b, Ribavirin, and high doses of vitamin B6 and B12.

What Are the Signs and Symptoms of Pyoderma Faciale?

Pyoderma faciale has various symptoms similar to rosacea and severe acne. The signs and symptoms of pyoderma faciale are mentioned below.

• Rapid onset of intense reddish papules.

• Cyanotic discoloration.

• Erythema or redness.

• Papules and pustules.

• Nodules are fluctuant.

• Abscesses with sinus tracts on the face.

• Symptoms are usually confined to the chin, cheeks, and forehead.

• Firm edema of the face.

• Scarring.

• Constitutional symptoms are absent.

• Eye involvement, including keratitis, conjunctivitis, and ocular perforation.

What Is the Diagnosis of Pyoderma Faciale?

The diagnosis of pyoderma faciale is mainly based on the clinical examination of the patient's symptoms and history. However, it is essential to make an early diagnosis of pyoderma faciale to avoid scarring and other risks of pyoderma faciale. Symptoms are primarily observed in middle-aged women and are mostly features such as papules, nodules, and abscesses confined to the face. Then, the biopsy is done, and the histological examinations are done to avoid misdiagnosing pyoderma faciale. The various diagnostic tools for the diagnosis of pyoderma faciale are mentioned below.

1. History of the patient.

2. Physical examination includes erythematous and edematous plaques.

3. Other symptoms include inflammatory nodules with an extensive area of necrosis.

4. Pustules.

5. Severe seborrhea on the face.

6. Comedones are absent.

7. A biopsy is taken, and by using a hematoxylin-eosin stain, the histopathological examination will show the following features.

• Hyperkeratosis in the epidermis.
• Follicular plugging.
• Rectification of the interpapillary cones.
• Dilated vessels in the papillary dermis.
• A mixed inflammatory process covers hair follicles.
• Neutrophils and lymphocyte infiltration.

What Is the Differential Diagnosis of Pyoderma Faciale?

The symptoms are similar in other skin conditions, especially in acne. Proper diagnosis is made to avoid misdiagnosis, and the differential features are essential to rule out differential diagnosis. Some of the differential diagnoses of pyoderma faciale are mentioned below.

• Acne.

• Rosacea.

• Gram-negative folliculitis.

• Gram-negative acne.

• Fungal infections.

• Mycobacterial infections.

Acne:

Clog in the sebaceous gland leads to the inflammation of the gland causing the conditions like acne and pimples. In addition, acne can sometimes lead to other skin problems, including whiteheads, blackheads, cysts, nodules, and spots. Acne can also appear in the face, shoulders, chest, arms, and back region.

How to Treat Pyoderma Faciale?

The possible side effects of the drug for the patient are closely monitored. Regular follow-ups are mandatory to avoid the symptoms worsening. In addition, patient education regarding the risk of scarring and other complications of pyoderma faciale is done. The therapeutic challenge involved in pyoderma faciale is pregnant and postpartum patients. In such cases, consultation with the patient's obstetrician, oral steroids, or antibiotics such as Erythromycin or Amoxicillin may be considered. Topical antibiotics, including Erythromycin and Clindamycin, can be used with the unreasonable expectation of improvement.

Topical Therapy:

• Topical mid to high-potency steroids.

• Fluocinonide 0.05% cream.

• Desoximetasone 0.25% cream.

• Clobetasol 0.05% cream.

Systemic Therapy:

• Oral steroids.

• Oral Isotretinoin.

• Oral antibiotics such as Tetracyclines, Minocycline.

• Macrolides such as Erythromycin or Azithromycin.

Optimal Therapeutic Approach for Pyoderma Faciale:

Initiate Therapy -

• With oral corticosteroids for two to four weeks, followed by Isotretinoin.

• Topical steroids can be used as adjuvant therapy.

• Steroids are advised to avoid symptoms worsening.

• In acute inflammatory conditions, Isotretinoin and corticosteroids are used.

What Are the Home Remedies of Pyoderma Faciale?

Home remedies are easily and readily available and can be used to treat rosacea fulminans. In addition, the side effects of drugs are absent in the available natural therapies. Some of the home remedies to avoid rosacea are mentioned below.

• Aloe vera.

• Chamomile.

• Coconut oil.

• Burdock.

• Feverfew.

• Comfrey.

• Oatmeal.

• Niacinamide.

• Lavender essential oil.

• Turmeric.

• Raw honey.

• Tea tree essential oil.

Conclusion:

Pyoderma faciale, also called rosacea fulminans, is an uncommon skin condition highly susceptible in females at a young age. The symptoms of pyoderma faciale resemble acne and rosacea. A proper diagnosis is made, and the treatment is done promptly to avoid scarring. Patient education regarding the drugs' side effects and the skin disease's severity is done to prevent pyoderma faciale.