Rapidly Progressive Rosacea in an Adult Male With Flushing Attacks, Pruritus, and “Freckles”

  • Jonathan K. Wilkin
Part of the Contemporary Internal Medicine book series (COIM, volume 3)


A 58-year-old man had a 12-month history of facial flushing and a progressively deteriorating facial “complexion.” He was a salesman who traveled frequently by automobile, and he had flushing attacks when traveling on hot days in his non-air-conditioned vehicle. Over the past year, the flushing had become more severe and was associated with a burning sensation of the face and copious rhinorrhea. He also described abundant “freckles” on his chest and back which appeared approximately one year before this presentation. Over the past few months he had noted an increase in pruritus and urticaria localized to these “freckles,” especially after ingestion of alcoholic beverages, after hot showers, and following aspirin ingestion. He described having one episode of explosive diarrhea weekly, almost always after ingestion of 3–5 cans of beer. Persistent rhinitis, epigastric discomfort, and watery, burning eyes had been problems over recent months. The pruritus and substernal burning sensation occurred during and shortly after the flushing reactions. There had been no localized skeletal pain, fainting spells, or bleeding problems.


Mast Cell Carcinoid Tumor Carcinoid Syndrome Systemic Mastocytosis Meibomian Gland 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Wilkin JK: Flushing reactions, Rook AJ, Maibach H (eds): in Recent Advances in Dermatology, vol 6. Edinburgh, Churchill Livingstone, 1983, pp 157–187.Google Scholar
  2. 2.
    Wilkin JK: Rosacea. Int J Dermatol. 22:393–400.Google Scholar
  3. 3.
    Starr PAJ, MacDonald A: Oculocutaneous aspects of rosacea. Proc. R Soc Med. 1969;62:9–10.PubMedGoogle Scholar
  4. 4.
    Findlay GH, Simson IW: Leonine hypertrophie rosacea associated with a benign bronchial carcinoid tumor. Clin Exp Dermatol. 1977;2:175.PubMedCrossRefGoogle Scholar
  5. 5.
    Wong VG, Melmon KL: Ophthalmic manifestations of the carcinoid flush. N Engl J Med. 1967;277:406–409.PubMedCrossRefGoogle Scholar
  6. 6.
    Marks R, Beard RJ, Clark ML, et al: Gastrointestinal observations in rosacea. Lancet 1967;1:379.Google Scholar
  7. 7.
    Domonkos AN: Andrews’Diseases of the Skin, ed 6. Philadelphia, WB Saunders Co, 1971, p 261.Google Scholar
  8. 8.
    Wilkin JK: Vasodilator rosacea. Arch Dermatol. 1980;116:598.PubMedCrossRefGoogle Scholar
  9. 9.
    Wilkin JK: Flushing reactions: Consequences and mechanisms. Ann Intern Med. 1981;95:468–476.PubMedCrossRefGoogle Scholar
  10. 10.
    Duncan MW, Compton P, Lazarus L, et al: Measurement of norepinephrine. Measurement of norepinephrine and 3,4-dihydroxyphenylglycol in urine and plasma for the diagnosis of pheochromocytoma. N Engl J Med 1988;319:136–142.PubMedCrossRefGoogle Scholar
  11. 11.
    Roberts LJ II, Fields JP, Oates JA: Mastocytosis without urticaria pigmentosa. A frequently unrecognized cause of recurrent syncope. Trans Assoc Am Physicians 1982;95:36–41.Google Scholar
  12. 12.
    Webb TA, Li CY, Yam LT: Systemic mast cell disease: A clinical and hematopathologic study of 26 cases. Cancer. 1982;49:927–938.PubMedCrossRefGoogle Scholar
  13. 13.
    Wilkin JK: Ethnic contact urticarial reaction to alcohol. Contact Dermatitis 1985;12:118–120.PubMedCrossRefGoogle Scholar
  14. 14.
    Wilkin JK, Fortner G: Cutaneous vascular sensitivity to lower aliphatic alcohols and aldehydes in Orientals. Alcoholism: Clin Exp Res. 1985;9:522–525.CrossRefGoogle Scholar
  15. 15.
    Wilkin JK, Stewart JH: Substrate specificity of human cutaneous alcohol dehydrogenase and erythema provoked by lower aliphatic alcohols. J Invest Dermatol. 1987;88:452–454.PubMedCrossRefGoogle Scholar
  16. 16.
    Wilkin JK: 4-Methylpyrazole and the cutaneous vascular sensitivity to alcohol in Orientals. J Invest Dermatol. 1988;91:117–119.PubMedCrossRefGoogle Scholar
  17. 17.
    Roberts LJ, Sweetman BJ, Lewis RA, et al: Increased production of prostaglandin D2 in patients with systemic mastocytosis. New Engl J Med. 1980;303:1400–1404.PubMedCrossRefGoogle Scholar
  18. 18.
    Granerus G, Wass U: Urinary excretion of histamines, methylhistamine (1-MeHi) and methylimidazoleacetic acid (MelmAA) as an indicator of systemic mastocytosis. Agents and Actions. 1984;14:341–345.PubMedCrossRefGoogle Scholar
  19. 19.
    Sagher F, Even-Paz Z: Mastocytosis and the mast cell. Chicago, 1967, Year Book Medical Publishers, Inc., pp. 4-242.Google Scholar
  20. 20.
    Granerus G, Roupe G, Swanbeck G: Decreased urinary histamine metabolite after successful PUVA treatment of urticaria pigmentosa. J Invest Dermatol. 1981;76:1–3.PubMedCrossRefGoogle Scholar
  21. 21.
    Barton J, Lavker RM, Schechter NM, et al: Treatment of urticaria pigmentosa with corticosteroids. Arch Dermatol 1985;121:1516–1523.PubMedCrossRefGoogle Scholar
  22. 22.
    Lorenz W, Uvnas B: Histamine assays: chapter-writing by consensus. Lancet. 1989;1:1278.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1991

Authors and Affiliations

  • Jonathan K. Wilkin

There are no affiliations available

Personalised recommendations