Case 4: What caused periorbital edema in this woman?

This 65-year-old woman seeks evaluation of asymptomatic swelling of her eyelids of 2 to 3 months’ duration. She has taken the same antihypertensive for years and denies any exposure history.

What is the likely cause of the swelling?

A. Cutaneous lupus.
B. Contact dermatitis.
C. Seborrheic dermatitis.
D. Rosacea.
E. Dermatomyositis.

(answer on next page)

Case 4: Lymphedema caused by rosacea

This patient had a rare variant of rosacea, D, that is associated with lymphedema. The periorbital edema may be marked and, on occasion, it is the presenting symptom. Medical treatment is typically long-term and is usually not successful.¹

It would not be unreasonable to do a skin biopsy to exclude lupus or contact dermatitis. However, lupus is usually tender, and contact dermatitis is typically pruritic. Seborrhea does not cause facial swelling. Dermatomyositis has been associated with lid edema, although other features of the condition would be expected to be present.

References:

REFERENCE:

1.

Chen DM, Crosby DL. Periorbital edema as an initial presentation of rosacea.

J Am Acad Dermatol.

1997;37(2, pt 2):346-348.