title: Rosacea Fulminans Precipitated by Acute Stress: A Case Report Describing an Integrative Approach for a Patient Reluctant to Use Isotretinoin.
abstract: BACKGROUND
  Rosacea fulminans is a rare skin disorder with a multifactorial etiology. Stress is one of the common precipitating factors of this condition but is not often targeted in treatment. Isotretinoin is considered part of the first-line therapy for this condition but, in cases where its use is restricted, other therapeutic interventions as part of an integrative approach may be effective.
  
  
  METHODS
  A 38-y-old female presented with rosacea fulminans brought on by an acutely stressful event. After multiple failed therapies, she experienced resolution of her symptoms with a combination of systemic corticosteroids, antibiotics, diet modification, and stress reduction, with the treatment of stress playing a significant role.
  
  
  CONCLUSIONS
  Stress management and diet modification are key adjunctive therapies in the treatment of rosacea fulminans and need to be addressed more often in treatment. In cases where patients are reluctant or unable to take isotretinoin, an integrative approach may be effective in achieving symptomatic improvement.
authors.affiliation: , is a medical student at Indiana University; , is assistant professor of clinical dermatology at Indiana University; is a resident at Geisinger Health.
authors.forename: Patrick
authors.initials: P
authors.lastname: Veerkamp
authors.affiliation: , is a medical student at Indiana University; , is assistant professor of clinical dermatology at Indiana University; is a resident at Geisinger Health.
authors.forename: Nico
authors.initials: N
authors.lastname: Mousdicas
authors.affiliation: , is a medical student at Indiana University; , is assistant professor of clinical dermatology at Indiana University; is a resident at Geisinger Health.
authors.forename: Robert
authors.initials: R
authors.lastname: Bednarek