Multimodal Management of Morbihan Disease: Isotretinoin, Intralesional Triamcinolone, and Ketotifen in a Recalcitrant Case

Morbihan disease, also known as rosacea-associated solid facial edema, is a rare and chronic condition that presents with persistent facial swelling and often proves difficult to treat. We describe the case of a 57-year-old man with a four-year history of right-sided facial edema who was diagnosed with Morbihan disease after extensive prior evaluations. Intralesional triamcinolone injections at a tertiary center produced his best response, and combination therapy with isotretinoin was recommended. At our clinic, isotretinoin was initiated at 20 mg daily and titrated over several months, with doses adjusted between 10 and 40 mg based on efficacy and tolerability. A reduction to 10 mg coincided with worsening edema, while escalation improved symptoms. Adjunctive therapies included topical roflumilast, oral ketotifen, and repeat intralesional triamcinolone. Serial laboratory monitoring revealed persistent hyperlipidemia, though liver and renal function remained normal, necessitating primary care referral for lipid management. The patient reported partial improvement, most notably with higher isotretinoin dosing and intralesional corticosteroid injections, though intermittent flares persisted. This case highlights the challenges of treating Morbihan disease, emphasizing the role of individualized isotretinoin dosing, intralesional triamcinolone as a useful adjunct, and the importance of close safety monitoring and patient-centered decision-making in managing this rare condition.