Granulomatous Rosacea (GR), first described in 19701, is thought to be a peculiar variant of rosacea thanks to the presence of granulomas at histopathological examination, although some authors sustain that it is a distinct histological variant found among most of the clinical spectrum of rosacea2 . GR is mostly reported in middle aged women and may present centro-facial localization3. Its histology is similar to that of Periorificial Granulomatous Dermatitis (PGD), although the latter is more common in the pediatric population4.

We present a peculiar case of a unilateral periorbital GR. A 22-year-old male in good health conditions had a dermatological consultation, complaining of a periorbital non-itching rash on the left side of his face that had been present for a few weeks. He denied any medical history or having used any topical or oral medication prior to the eruption’s onset. At clinical examination (Figure 1) papules and pustules on an erythematous background were found on the left periorbital area, whereas the contralateral side was unaffected. Mucous membranes were uninvolved and there was no palpable lymphadenopathy. Dermoscopy examination (Figure 2) showed widespread linear vessels arranged in a polygonal network and follicular opening containing whitish-grey plugs.  

Histology revealed moderate acanthosis with dilation of the hair follicles infundibula with some keratin plugs. Telangiectatic vessels were visible in the dermis, together with prominent perivascular lymphoplasmacytic infiltrate and perifollicular epithelioid granulomas (Figure 3). Stains for acid-fast bacilli (i.e. Ziehl-Neelsen) were negative. No abnormalities emerged at the serological routine exams.

Background: Herpes zoster (HZ) is often accompanied by severe neuropathic pain, known as herpes zoster–related pain (ZAP), which greatly impairs patients’ quality of life. Hyaluronic acid (HA) possesses anti-inflammatory and neuroprotective properties. Previous studies have shown that subcutaneous injection of 35 kDa HA fragments can rapidly relieve various types of pain, including ZAP. This study aimed to evaluate the analgesic efficacy of a 10% high-concentration 35 kDa HA fragment (HA35) gel applied topically in patients with ZAP. Methods: Four patients with ZAP (aged 57–77 years) were included. All received topical application of 10% HA35 gel; one patient additionally used a skin protective film to prevent gel drying. Pain intensity was assessed using the Numeric Rating Scale (NRS, 0–10) before and after treatment. Results: In three patients with acute ZAP, the mean NRS score decreased by approximately 55% within 2 minutes after application and dropped to 1–2 after 20 minutes, with analgesic effects lasting about 4 hours. In one patient with postherpetic neuralgia (PHN), the combination of HA35 gel and skin protective film extended the analgesic duration beyond 8 hours and significantly reduced erythema and swelling. Conclusions: The 10% high-concentration HA35 gel provided rapid and safe analgesia in ZAP, and the addition of a skin protective film further prolonged the duration of pain relief. This non-invasive, simple, and well-tolerated method offers a promising new topical approach for managing ZAP.