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.