Solid facial edema: Treatment failure with oral isotretinoin monotherapy and combination oral isotretinoin and oral steroid therapy

Solid facial edema is a rare condition most commonly associated with acne vulgaris. The clinical presentation is consistent with localized, symmetric, non-pitting, non-painful edema over the glabellar region, midface, nasal saddle, and infraorbital regions. Most reported cases are males in their late teens or early twenties who present with a multi-year history of acne followed by a recent onset of persistent edema [1-11]. The pathogenesis is not well defined, making this condition difficult to treat [4, 12, 13]. Hot water injections, x-ray radiation, and topical steroids have been used in the past [1, 2], and more recently, oral antibiotics, oral steroids, isotretinoin, and surgical procedures have had varying degrees of success [1-21]. Only one previous case reported a failure of isotretinoin therapy in solid facial edema [2]. Herein, we report a patient with solid facial edema who failed a 4-month course of isotretinoin monotherapy and a 1-month course of oral prednisone in combination with isotretinoin. We also discuss the differential diagnosis and various treatment options.