A fair-skinned patient with chronic facial papules and pustules around the nose and mouth is most likely which condition?

• A. Acne vulgaris
• B. Rosacea
• C. Seborrheic dermatitis
• D. Perioral dermatitis

Answer: (B)

Rosacea presents with chronic facial redness and noncomedone papulopustular lesions concentrated on the central face, especially around the nose, cheeks, and chin, often in fair-skinned adults. The described pattern—persistent papules and pustules around the nose and mouth without prominent comedones—fits this central-face involvement and helps differentiate it from acne vulgaris, which typically features comedones and broader adolescent patterns. Seborrheic dermatitis would show greasy scales and erythema in areas like the scalp, eyebrows, and nasolabial folds rather than a focal papulopustular eruption of the central face. Perioral dermatitis tends to produce small papules around the mouth, sometimes with a spared vermilion border, and may not include the flushing and telangiectasias seen in rosacea. In this presentation, the central-face papulopustular pattern in a fair-skinned patient points to rosacea.