SEVERE ROSACEA WITH INCIPIENT RHINOPHYMA IN A PEDIATRIC PATIENT: COMPREHENSIVE MEDICAL-SURGICAL MANAGEMENT. CASE REPORT AND NARRATIVE REVIEW

Abstract

DOI: https://doi.org/10.46296/gt.v9i17.0367

Abstract

Background: Rosacea is a chronic inflammatory centrofacial dermatosis, common in adults but uncommon in children. Severe pediatric rosacea with nasal phymatous changes suggesting incipient rhinophyma is exceptional and requires careful exclusion of acne vulgaris, steroid-induced dermatitis, lupus erythematosus, sarcoidosis, demodicosis and granulomatous dermatoses. Case: A 13-year-old male presented with an 18-month history of persistent centrofacial erythema, heat- and sun-triggered flushing, inflammatory papules and pustules on the cheeks and nasal dorsum, telangiectasias, marginal blepharitis and progressive nasal skin thickening without comedones. Diagnosis was supported by clinical assessment, dermoscopy, ophthalmologic examination, exclusion of mimickers and a skin biopsy consistent with inflammatory rosacea, sebaceous changes and early dermal fibrosis. Management included education, discontinuation of topical corticosteroids, photoprotection, gentle skin care, topical ivermectin, age-appropriate doxycycline, ocular care, psychosocial support and close follow-up. Persistent inflammatory nasal hypertrophy led to low-dose isotretinoin under pediatric dermatology monitoring, followed by limited fractional CO2 laser reshaping, achieving cosmetic and functional improvement without relevant complications. Conclusion: Severe pediatric rosacea with phymatous change requires early recognition, multidisciplinary care and staged treatment. In selected adolescents, combined anti-inflammatory therapy, monitored systemic retinoids and conservative procedural treatment may control inflammation, limit phymatous progression and reduce psychosocial burden.

Keywords: pediatric rosacea; rhinophyma; phymatous rosacea; isotretinoin; CO2 laser; pediatric dermatology; case report.