Re ‘Isolated eyelid edema in Melkersson–Rosenthal syndrome: a case series’

Abstract

Sir, Rawlings et al1 have reported on a series of five patients with isolated eyelid edema and have made the diagnosis of Melkersson–Rosenthal syndrome on the basis of granulomatous inflammation. Melkersson–Rosenthal syndrome is described as a granulomatous disease with the triad of facial palsy, facial edema, and a fissured tongue, although the complete triad is reported to be seen in only 25% of cases.2 We have recently reported on a series of 15 patients with chronic eyelid edema, and in 9 of these cases (60%) there was an associated diagnosis of acne rosacea.3 Granulomatous inflammation was present in some of these patients, and this has been reported before in the presence of acne rosacea.4 Indeed, acne rosacea and Melkersson–Rosenthal syndrome have some overlap in their clinical and pathological features and both are classified as granulomatous dermopathies. The illustrations of Cases 1 and 2 in the series of Rawlings et al1 show facial features that would be consistent with acne rosacea, with rhinophymatous change and thickened glabellar skin. I suspect these two illustrated patients do indeed have acne rosacea rather than Melkersson–Rosenthal syndrome, and it would be of interest to know whether any of the other three patients in the series also showed features of rosacea. It is likely that Melkersson–Rosenthal syndrome is over diagnosed when the other features of the syndrome are absent, and many of the reported cases of eyelid edema as the only feature of the syndrome are more likely to have acne rosacea as the underlying cause of their eyelid edema. Such phymatous change in the eyelid was certainly the commonest cause in our series, which to date is the largest published series of chronic eyelid lymphedema.