A 20-year-old man suffering from acne vulgaris since the age of 12 developed a solid persistent inflammatory edema of the face through the last 2 years. The edema was resistant to conventional treatment of acne including various systemic and topical antibiotics, isotretinoin and interferon-gamma. Histopathologic examination revealed an extensive fibrosis of the middle and deeper corium with a dense lymphohistiocytic perivascular infiltrate, notably with many mast cells. The therapeutic combination of oral isotretinoin (0.5 mg/kg body weight daily) and ketotifen (2 mg daily) led to complete resolution of all facial lesions. The pathogenesis of persistent edema remains mysterious but may be related to chronic inflammation resulting in obstruction of lymph vessels or fibrosis induced by mast cells.
Jungfer B, Jansen T, Przybilla B, Plewig G