Rosacea, But Not on Your Face; it is possible

One often asked question by newly diagnosed sufferers is `can you get rosacea on areas other than your face’. The usual answer is no; you normally only see rosacea symptoms on the flushing zone areas in the central areas of your face.

Extrafacial Rosacea is a Thing

This paper slightly dispels this idea with a case report about one patient who had rosacea lesions on his arm, and upper chest area.

Rosacea with extensive extrafacial lesions, Int J Dermatol. 2008 Jan;47(1):52-5, Pereira TM, Vieira AP, Basto AS

Rosacea is a very common skin disorder in the clinical practice that primarily affects the convex areas of the face. Extrafacial rosacea lesions have occasionally been described, but extensive involvement is exceptional. In the absence of its typical clinical or histological features, the diagnosis of extrafacial rosacea may be problematic. We describe an unusual case of rosacea with very exuberant extrafacial lesions, when compared with the limited involvement of the face.

The patient had papules, red nodules, pustules and large granulomatous lesions involving the face, neck and upper chest, and extending from the left shoulder along the whole left arm. It was mostly missing from the central facial region. Demodex was not seen as a possibility.

The treatment regime was deflazacort (an oral steroid) 30mg for 3 weeks, azithromycin at 500mg, 3 days a week for 4 weeks and isotretinoin (accutane) 10mg a day for 1 year. The accutane was reduced in the later months. The patient was advised to avoid the sun and use a physical sunscreen (i.e. zinc oxide or titanium dioxide based).

After 1 year, the chest, left shoulder and arm were clear, with some facial redness remaining.

In order to diagnose these symptoms as being rosacea-like, the doctors had to rule out several other possibilities like infectious folliculitis and demodicosis.

Therefore, in this case, the presence clinically of inflammatory papules, pustules, and nodules on a congestive background, with spread from the typical midfacial involvement to other areas of the body, and the presence of poorly organized epithelial granulomas and follicular pustules in the biopsy allow the diagnosis of extrafacial rosacea.

A review of 53 cases of granulomatous rosacea found extrafacial lesions in 15% of the patients.

Interestingly the patient was treated with low-dose accutane and pulse dosing with azithromycin. A 3 week dose of oral steroids was also included.

The paper ends with the following conclusion.

Reports of extrafacial rosacea are rather scarce. However, it may be more common than it is thought, because it is generally not considered and/or not researched. We presented an unusual setting of extrafacial rosacea that is remarkable for the exuberant and extensive involvement, when comparing with facial involvement, the initial diagnostic difficulty and the good therapeutic results obtained

Your Extrafacial Rosacea

What about you, have you ever suspected that you have `extrafacial rosacea’ ? How did you treat it ? Leave a comment below.

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About the Author: David Pascoe started the Rosacea Support Group in October 1998. .

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13 Reader Comments

  1. jo says:

    hello? i am going to the derm on Thursday and begg him for accutane. I have rosacea bad and cant take it anymore!!! I also have a very very oily face ( hoping accutane takes care of this even if he only gives me a low dose) and some huge painful pimples … needless to say I am not very attractive!!!!! If I could hide my life away in a paper bag I would.

    Please hope for me that he gives me accutane.

    Jody

  2. beth says:

    i do think i have it, on my upper chest. this has always gotten red, and often gets little itchy bumps, that stay for a week or so. sometimes it happens right out of the shower. this has happened since i was 12 yrs. old. my dermatologist said it wasn’t rosacea, but i do know this, my skin there reacts to the strangest things, most of the time. soaps, smells, emotion, heat/cold. it’s definately something, if not rosacea.

  3. Val says:

    I have been getting out breaks on my mouth and the dermo, diagnosed me with Rosacea. I am skeptical of this becuase it is not listed as one of the places rosacea appears. I get outbreaks from the sun and stress seem to be my triggers.

  4. Hi Val,

    It is impossible to diagnose over the internet of course, but one possible alternative diagnosis is perioral dermatitis. A dermatologist is likely to be able to tell the difference between the two, so I’d be tempted to stick with your current diagnosis for now.

    davidp.

  5. I read all the information I can find with great personal interest. I have gone, through the years, from adult acne to resistant adult acne to rosacea. When I finally realized it wasn’t adult acne, I really looked into the characteristics of rosascea, I knew I had found an answer. Demodex mites. I fit the profile, have had these for years, but didn’t know those critters were alive! They are so alive. Did some extensive reading online and found European researchers have known about these mites for years, but U.S. derms deny their exsistence. I have been recently been treated with a round of ivermectin, with some success. I truly believe demodex mites are the human equivilant of the cockroach! I think they cause and excaserbate and cause many problems. Sometimes in science the most elegant answer to unsolvable problems are simple and right in front of us. I will be following this site with anticipation.

  6. Jennifer says:

    Hmmm, I have the same sort of acne on my chest as my face and over the years it has spread to cover from a small central area to 2/3rds of the chest area.The pustules are not as bad as my face. It doesn’t seem to be rosacea but it does get burnt easily from the sun. (which I try to avoid) My whole body is easily burnt, 5 minutes in the sun hanging out washing is all that is needed if I forget the sunscreen to result in an eczma like reaction. Small intensely itchy lumps form 1 or 2 days after exposure.
    I also get the odd large pustule in various odd places.
    I too have wondered about demodex, as it literally feels like my skin (face) is crawling.
    In winter the hot shower burns me and leaves me dry and itchy. So all my skin is reactive in some way. And now that I have read the info on inflammation I wonder why my muscles are always in spasm.

  7. mary says:

    I got rid of rosacea papules in 48 hrs using hair conditioner with tea tree oil in it. Had just been diagnosed with rosacea by a dermatologist. Had never heard about demonex before that. The rosacea is very mild, but the papules had me in a panic.

    The hair conditioner felt wonderful over the needle-like itchy spots. I don’t know the concentration of tea tree oil. Full strength will burn if the skin is not completely healthy. The brand I used is Holista.

    I have since started using the matching shampoo and my dandruff has disappeared. Maybe this will help someone.

  8. Ashley says:

    I have “extra-facial” redness. For the most part, I think it was caused (or at least exacerbated) by Benzoyl Peroxide therapy. So when I’m too warm, nervous, embarrassed, etc., my whole face, neck, chest and upper arms flush. It’s really embarrassing :\. This means that I don’t have proper barrier function from the BP use, right? Probably also really thin skin. If anyone knows anything, I appreciate your feedback.

  9. Mark L. says:

    I’ve been diagnosed as having inflammatory rosacea on my scalp a few years ago. With no rosacea problems on my face (as far as I know), until a few months ago. Is rosacea of the scalp rare? Should I search out a different opinion from a different dermatologist?

  10. Sarah says:

    I don’t have particularly severe rosacea, but I’m getting scattered papules on my neck and chest as well as my face. They tend to be a bit more itchy or uncomfortable than the facial ones. I’m only treating my rosacea topically so far, but I can’t be bothered to use the topical on the extrafacial skin except to “spot treat” lesions when they appear. If it gets bad, I may have to go the oral route.

  11. Sarah says:

    BTW, I do get them around my mouth, too. I don’t think it’s perioral dermatitis b/c everything looks classically rosacea-like and the ones around the mouth do improve with metronidazole just like everywhere else.

  12. Lynn says:

    I have what looks like Rosacea on both arms. I have been using a Rosacea cream for years on my face but to tell you the truth I don’t see much difference. I was tested for lupus and it was neg. My rosacea isn’t as bad as most of the pictures I have seen. Mostly red and broken blood vessels . I usually can cover it with make up but my arms are a different story. My arms and upper chest stay red and I get what looks like white heads some will pop others don’t all down my arms. Anyone got any ideas what it could be?

  13. Debbie says:

    I am a 53-year old female diagnosed with Rhinophyma, due to Rosacea. My nose is swollen and I have a raised, elongated patch which keeps spreading. As this patch of skin spreads, it tingles. I also have swelling on my chin and forhead and get frequent nasal infections. Currently I am using a compound cream which contains a steroid. I asked my Dermatologist if there were any studies being done in Canada and he told me that there weren’t any. I would really like to be involved in a study of this disfiguring disease, so that I may help to find a cure. Any assistance with this disease would be greatly appreciated. Regards, Debbie

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