Phosphodiesterase-5 inhibitors and rosacea: report of 10 cases

Abstract

Conflicts of interest: none declared. Sir, Certain medications, such as amiodarone or topical steroids, have been considered triggers or causal agents of rosacea or rosacea‐like eruptions.1 However, to our knowledge this is the first study reporting development of rosacea following administration of phosphodiesterase‐5 inhibitors (PDE5i). We report 10 men, with a mean age of 53·6 years, who attended our Department of Dermatology from January 2006 to January 2008, complaining of facial erythema, telangiectasias, burning sensation, photosensitivity and intermittent episodes of inflammation with papules, lasting for at least 4 months (Fig. 1a). Their personal medical history was unremarkable, except for the recent initiation of treatment with PDE5i for erectile dysfunction (ED) that was followed by the development of the previously described symptoms and signs. Only two patients reported sporadic episodes of transient erythema that preceded PDE5i initiation. The patients’ most significant clinical and histological features are summarized in Table 1. All 10 patients met the clinical criteria for the diagnosis of rosacea. Punch biopsies from the affected skin were performed. Ectatic venules and lymphatics with perivascular and perifollicular lymphohistiocytic and neutrophilic infiltration were the most prominent histological alterations (Fig. 1b). Additional histological features included moderate elastic tissue hyperplasia, slight oedema and mild actinic elastosis. The presence of the required clinical diagnostic criteria in combination with the histological features confirmed the diagnosis of rosacea. Seven of our 10 patients had the erythematotelangiectatic subtype, while three were classified as having the papulopustular subtype. All 10 individuals were of skin phototype II.