Introduction

Facialedema is an unusual and poorly understood condition, unfavourably affecting a patients self-esteem and mental health. It can be a stern complication of acne vulgaris and rosacea, also associated with other congenital, infectious, malignant, and inflammatory processes.

Facial edema results from impaired lymphatic drainage. Therefore, it is possible that solid persistent facial edema may represent a separate disease entity. Herein, we discuss a patient who presented with facial edema and reacted well to isotretinoin and compression therapy.

Case report

A 32-year-old man with no history of significant acne vulgaris, rosacea, or visual complaints presented with an 8-month history of persistent left periorbital swelling. He had previously been evaluated by multiple physicians.

Physical examination revealed non-erythematous, non-pitting edema of the left periorbital aspect of the face, with no conjunctival inflammation. He received a diagnosis of “persistent localized edema.”Series patch testing, a negative tuberculin skin test result, and histology showing numerous dermal ectatic blood vessels and lymphatics and a sparse infiltrate of lymphocytes.

After 3 months of treatment with isotretinoin, there was slight clinical improvement, and night compression therapy was initiated, consisting of a full facial plastic mask with elastic compression straps produced by a physical therapy clinic. Within 2 months, there was significant clinical improvement, and the isotretinoin dose was decreased to 40 mg every other day. Continued clinical perfection was achieved during the subsequent 15 months, at which time isotretinoin was discontinued.

Conclusion

Isotretinoin seems to recover facial edema through its anti-inflammatory and immunomodulatory effects

Reference: JAAD Case Rep. 2020 Aug; 6(8): 755–757