Is this Morbihan's Disease? What role do you think ten years
of hydrocortisone cream plays in the genesis of her problem?
Do you have any therapeutic suggestions? D.B. is anxious to
have her old face back.
1. Holzle E, Jansen T, Plewig G. [Morbihan disease--chronic
persistent erythema and edema of the face] Hautarzt. 1995 Nov;46(11):796-8.
[Article in German] Hautklinik und Poliklinik, Universitats
Krankenhauses, Eppendorf, Universitat Hamburg.
Morbihan's disease was first reported as a distinct entity
in 1957 by Degos, describing a chronic persistent erythema and
oedema of the upper half of the face. Such conditions have been
noted in the literature designated as
chronic lymphoedema or solid persistent facial oedema in acne
or rosacea. The characteristic features are a chronic course,
a typical clinical picture, lack of specific laboratory and
histological findings and refractoriness to
2. Harvey DT, Fenske NA, Glass LF. Rosaceous lymphedema: a
rare variant of a common disorder. Cutis. 1998 Jun;61(6):321-4.
Division of Dermatology and Cutaneous Surgery, University of
South Florida College of Medicine 33612, USA.
Rosaceous lymphedema is considered to be a rare and disfiguring
variant of acne rosacea. Cases remain difficult to treat and
can challenge afflicted patients both cosmetically and psychologically.
We describe an unusual presentation of rosaceous lymphedema
and review the differential diagnosis of persistent
Comments from Members
Yelva Lynfield MD, Cedarhurst, New York, USA on
Mar 21, 2004
Poor woman! All those medical and psychiatric problems plus
a complication of rosacea that is visible to everyone! Please
give her some doxycycline and let us know whether it helps.
Jairo Messa MD, Manizales, Columbia on Mar
I saw a case in past with good response to isotretinoin
Julian Manzur MD, Havana, Cuba on Mar 21,
Very interesting`patient. I have never seen a patient with
rosaceous lymphedema. Sure, she needs all our efforts to improve
Khaled El-hoshy MD, Troy, Michigan,USA on
March 22, 2004
Consider Melkersson-Rosenthal syndrome; SVC syndrome; Rosacea/acne
?trial of furosemide. Check thyroid.
Sunil Dogra MD, Dept. of Dermatology, Postgraduate
Institute of Medical Education and Research, Chandigarh, India
on Mar 23, 2004
It was indeed an interesting case but challanging from the
therapy point of view. I will like to treat such case with low
dose oral isotretinoin for a long period. Low dose oral prednisolone
for short period may also be considered in the initial period
to reduce inflammation and edema.
Farid Youssef MD, Cairo, Egypt on Mar 25,
A very interesting case. I never saw one like it before will
be great to see the effect of ketotifen 1-2mg /day in combination
with isotretinoin 0.2-0.5mg/kg/day for 4-5 months. Reported
to work in Morbihan's disease.
Nidal Dabbour MD, Saudi Arabia on Mar 26,
Hydroxychloroquine 200mg twice daily was effective in a young
man with same clinico-pathological presentation
Abir Saraswat MD, Lucknow, India on March
The underlying cause for her rosacea may be revealed if the
treatment history is probed a little more. Her list of (intermittent)
medications does not include any drug for her asthma. If she
has been on high dose inhaled/ low dose oral steroids for it,
that may be the reason, rather than off-and-on hydrocortisone
cream. As regards treatment, isotretinoin may be best, but will
she be able to afford it without insurance? Bipolar disorder
may also be a (controversial) contraindication.
Caroline Koblenzer M.D., Professor of Dermatology and
Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
on October 1, 2004
I would think that this is a dead-ringer for Morbihan's disease,
and I too would think in terms of isotretinoin. What about protopic
? and also facial massage? Does she see a psychiatrist at all?
I guess not, given her lack of insurance. Regular visits to
a therapist would of course be helpful, in terms of living with
the disfigurement. I don't know what the prognosis is----I guess
we'll have to wait for the next Blue Journal, where I expect
to see therapy and prognosis discussed, in Part 2 of the CME