Our Dermatol Online Our Dermatol Online 2081-9390 Our Dermatology Online Poland OURD-10-314 10.7241/ourd.20193.29 Letter to the Editor Rosettes within rosacea Aqil Niema Nassiri Aicha Moustaide Kaoutar Gallouj Salim Mernissi Fatima Zahra Department of dermatology, Hassan II University Hospital Center, Fes, Morocco Corresponding author: Dr. Niema Aqil, E-mail: niemaaqil90@gmail.com 2019 10 3 314 314 24062018 29102018 Copyright: © Our Dermatol Online 3 2019

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 <p>Sir,</p> <p>A 43-year-old woman presented with recurrent flushing of the face and redness, erythematous lesions of the face with hypersensitivity to heat. These symptoms had persisted for 4 years, with intermittent remissions lasting up to 2 months. A physical examination revealed facial erythema, telangiectasia, papules and pustules of the midfacial region with some scales and crusts. (<xref ref-type="fig" rid="F1">Fig. 1</xref>) Dermoscopy revealed linear vessels characteristically arranged in a polygonal network, creamy and whitish linear areas and a clear rosette sign. (<xref ref-type="fig" rid="F2">Fig. 2</xref>) The rest of the somatic examination was without abnormalities. An ophthalmological examination showed no evidence of keratitis, conjunctivitis or blepharitis. On these bases a diagnosis of papulopustular rosacea was made. The patient was treated with doxycycline for a total of 12 weeks, which led to a significant improvement.</p> <fig id="F1"> <label>Figure 1</label> <caption> <p>Facial erythema, telangiectasia, papules and pustules of the midfacial region with some scales and crusts.</p> </caption> <graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="OURD-10-314-g001.tif"/> </fig> <fig id="F2"> <label>Figure 2</label> <caption> <p>Dermoscopy showing linear vessels characteristically arranged in a polygonal network, creamy and whitish linear areas and a clear rosette sign.</p> </caption> <graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="OURD-10-314-g002.tif"/> </fig> <p>The rosette sign has been previously observed by Cuellar and colleagues and has been described as a new dermoscopic sign in actinic keratoses, which may be due to alternating areas of orthokeratosis and parakeratosis [<xref ref-type="bibr" rid="ref1">1</xref>]. Recently, Liebman and his collaborators have pointed out that the rosette sign is an optical effect of polarized light and that its interaction with keratin-filled adnexal openings is observable in a wide range of cutaneous neoplasia [<xref ref-type="bibr" rid="ref2">2</xref>]. This correlation could also explain the presence of this sign in rosacea too.</p> <sec id="sec2-1"> <title>Consent

The examination of the patient was conducted according to the Declaration of Helsinki principles.

 REFERENCES Cuellar F Vilalta A Puig S Palou J Salerni G Malvehy J New dermoscopic pattern in actinic keratosis and related conditions Arch Dermatol 2009 145 732 Liebman TN Scope A Rabinovitz H Braun RP Marghoob AA Rosettes may be observed in a range of conditions Arch Dermatol 2011 147 1468

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Conflict of Interest: None declared.