Case History:  

         A 24 year old male with a history of taking Accutane 2 years prior presents with a long history of chronic facial flushing and redness over most of his face.  He also complains of eye irritation and chronic redness of the eyes.  He was given the diagnosis of mild Rosacea by his last physician but after trying topical metronidazole and the flushing worsened, he is unsure what to do next.  He complains of ultra, ultra-sensitive skin in general and says that any cleanser, acne product, and even water itself makes the flushing worse and then causes an oily reaction.  He stills tries, but pays the consequence any time he attempts to get his face completely clean.  He had tried all the products that were made for “intolerant” and “sensitive” skin with no relief.  His face feels uncomfortable all the time and his life is clearly being affected by the condition.  Alcohol consumption, sun exposure, and increased stress cause the flushing and irritation to feel more uncomfortable.

     On physical examination, the young man does not have disfiguring redness from a distance.  On closer inspection, his skin appears slightly pinkened and irritated with mild acne and blackheads. His skin seems slightly oilier than normal skin.  His eyes seem injected with red vessels and his lids are a little irritated,  but no gross visual or eye abnormalities.  His demeanor seems very anxious and he appears to flush more from the nervousness of being examined. 

What is his diagnosis?

A) Rosacea

B) Post-Accutane side effects

C) Anxiety Disorder

D) Seasonal Allergies

E) Seborrheic Dermatitis

F) Eczema (contact dermatitis) 

What treatment would you recommend?

A) Oral Tetracycline

B) Paxil

C) Stress relieving exercises/activities

D) Anti-Histamines

E) Antifungal cream

F) Cortisone cream