A man in his 80s with a pacemaker; a history of congestive heart failure, coronary artery disease, atrial fibrillation, transient ischemic attack, and Parkinson disease; and dependence in all activities of daily living presented to the dermatology department with a 4-month history of new-onset persistent facial eruption. He denied a history of facial flushing. The patient was initially treated for rosacea at an outside hospital with topical 1% metronidazole cream for 1 month without improvement and developed acute facial purpura after 1 day of treatment with oral doxycycline, which was discontinued. Because of the eruption’s rapid onset and violaceous appearance, as well as empirical treatment failure, the patient was referred for further evaluation. On examination, the patient had asymmetric, centrofacial, erythematous-violaceous indurated telangiectatic and ecchymotic plaques over a phymatous background (Figure, A). A series of punch biopsies were performed (Figure, B-D).

一个80多岁的男人，带起搏器；有充血性心力衰竭，冠状动脉疾病，房颤，短暂性脑缺血发作和帕金森病的病史；并向皮肤科提出了日常生活中所有活动的依赖，并伴有新发持续性面部爆发4个月的历史。他否认有面部潮红的病史。该患者最初在外面的医院使用局部1％甲硝唑乳膏治疗酒渣鼻1个月而无改善，并在口服强力霉素治疗1天后出现急性面部紫癜，但已停用。由于爆发的快速发作和外观呈紫红色，以及经验性治疗失败，因此将患者转诊作进一步评估。经检查，患者出现不对称，中心面，红斑-紫胶硬结的毛细血管扩张和瘀斑（图，A）。进行了一系列打孔活检（图，BD）。