Rosacea fulminans with extrafacial lesions in an elderly man: successful treatment with subantimicrobial-dose doxycycline.

Rosacea fulminans, previously known as pyoderma faciale, is a rare disease occurring almost exclusively in young women characterized by the sudden eruption of coalescing papules and pustules, and large cystic nodules limited to the face. Patients generally respond well to standard therapy consisting of systemic isotretinoin in combination with topical and systemic corticosteroids. Lesions usually resolve with minimal scarring with appropriate management. We describe an elderly male patient with extrafacial rosacea fulminans successfully treated with daily subantimicrobial (40mg) dose doxycycline (SDD). To our knowledge, this is the first report of rosacea fulminans with extrafacial lesions in an elderly male. We suggest that SDD may be a safe and effective alternative, particularly for those unable to tolerate standard therapy.