THERAPEUTIC HOTLINE: Successful treatment of Morbihan's disease with oral prednisolone and doxycycline

Abstract

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.

Successful Treatment of Morbihan Disease with Long-term Minocycline and its Association with Mast Cell Infiltration

“…In one case, the combination of prednisolone of 20 mg/day for 2 weeks and doxycycline of 200 mg/day for 12 weeks improved the oedema and erythema (11). In contrast, minocycline monotherapy for 6 to 7 months did not show apparent improvement (dosage not avail able) (8).…”

Successful Long-term Use of Oral Isotretinoin for the Management of Morbihan Disease

“…Generally, little to no improvement in facial edema is noted with the use of pharmacological agents, leading many clinicians to pursue more invasive, yet also unreliable, treatments such as blepharoplasty, carbon dioxide laser, and local injections. 6,10,11,13,20,21 There are fewer than a handful of publications documenting the use of oral isotretinoin for the treatment of MD, which was first described by Jansen and Plewig 22 in 1997; however, all publications report its use in combination with oral corticosteroids or antihistamines, and treatment duration has varied from 6 to 16 weeks, with daily dosing between 10 and 50 mg. 5,10,22 Also, these treatment regimens were marked by incomplete or transient improvements in clinical findings 6,10,22,23 ; yet the notable improvement in both facial erythema and edema was indicative of oral isotretinoin as a promising therapeutic option compared with other pharmacological agents. It is possible that the conservative dosing and brief treatment duration documented in these reports contributed to the partial success of isotretinoin therapy for MD.…”

“…11,13 These agents have been used alone or in combination. At best, they are associated with a reduction of facial erythema; however, more often than not, the clinical response is partial and short-lived.…”

“…A substantial clinical improvement was not noted until 6 months of treatment in all 5 cases. Representative clinical pictures of the response to oral isotretinoin therapy are shown in the [10][11][12] ; however, the clinical response with these therapies has largely been inadequate. There have been reports of more invasive interventions, including surgical reduction, carbon dioxide laser blepharoplasty, and radiography, with unpredictable outcomes.…”

“…Reported systemic therapy for the treatment of MD includes anti-inflammatory drugs such as systemic corticosteroids, oral antibiotics, thalidomide, and antihistamines, [10][11][12]19 which generally overlap with the management of rosacea. 11,13 These agents have been used alone or in combination.…”