Rosacea fulminans in the early course of a pregnancy by in vitro fertilization with embryo transfer

Background. - Rosacea fulminans is a rare and severe form of rosacea, with acute onset in women between 20 and 40 years. Although the aetiology remains unknown, pregnancy has been reported to be a triggering factor. We report a case of rosacea fulminans occurring at the onset of pregnancy and discuss a possible triggering role of endocrine factors, as well as therapeutic options. Case report. - A 32-year-old woman with no previous history of dermatological disease consulted for rosacea fulminans appearing within the first three weeks of her first pregnancy, which required hormonal stimulation with recombinant FSH (follitropin alpha, Gonal F (R)) and an LHRH inhibitor (cetrorelix, Cetrotide (R)). She did not use topical corticosteroids or any other medication and had no other abnormalities at clinical examination. The skin disease tasted throughout pregnancy despite different treatments. After delivery, moderate improvement was observed within two weeks. Treatment with isotretinoin 0.5 mg/kg/day was started three months after delivery and led to the disappearance of the papular and pustular lesions within three weeks, with persistence of the erythema for six months. Discussion. - The patient had never previously presented from acne or rosacea and the question of the responsibility of hormonal changes induced by stimulating ovulation or pregnancy can be raised. However, since her rosacea tasted throughout pregnancy, a causal role of the drugs used for ovarian stimulation appears unlikely. We suggest that pregnancy was the major triggering factor in this case. The recurrence of the skin disease on a subsequent pregnancy would constitute a strong argument to support this hypothesis and rule out simple co-incidence. (C) 2008 Elsevier Masson SAS. Tous droits reserves.