Persistent facial swelling can occur as a rare complication of rosacea. This finding is referred to as lymphedematous rosacea or Morbihan's disease. We report a case of a 45-year-old male with no previous history of rosacea who developed bilateral periorbital swelling associated with facial erythema and edema that responded to a combination of oral corticosteroids and doxycycline. Biopsy revealed changes of granulomatous rosacea.

We report a series of four patients who presented with complaints of diffuse non-scarring alopecia. They had similar clinical features of alopecia, hyperseborrhea, and distinct keratinaceous hair casts that encircled the hair shafts. Propionibacterium acnes was isolated from two of the patients’ scalp, and Gram-positive, Giemsa-positive bacteria were seen in the hair follicles in the scalp biopsy of one of the patients. The patients’ symptoms did not respond to standard treatment for seborrheic dermatitis, but responded to a course of systemic antibiotics targeting P. acnes. We propose a role for P. acnes colonization of the terminal hair follicles in the pathogenesis of hair casts, and possibly diffuse non-scarring alopecia. Possible mechanisms of pathogenesis are discussed with a literature review.

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