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Multiple persistent keratoacanthomas

doxycycline, ciprofloxacin, and metronidazole. By contrast, the vasoactive properties of tacrolimus explained the insidious development of rosaceiform complication during long-term treatment in the previous report, 7 especially in patients with a history of rosacea. Our patient had no history of rosacea, however, and his rosaceiform complication showed an acute course and no recurrence. A typical flush reaction to even small amounts of alcohol has been observed in up to 7% of patients treated with tacrolimus ointment. 10 Pimecrolimus, however, does not appear to have vasoactive effects. A similar reaction pattern has not been noted with extensive pimecrolimus use in clinical trials. Finally, topical pimecrolimus 1% cream is in a cream base and seems to have less occlusive properties than tacrolimus ointment. Thus, the rosacea-like demodicidosis in our patient is probably related to the local immunosuppressive effects of topical pimecrolimus 1% cream. Pimecrolimus 1% cream is increasingly being used because of its therapeutic benefit in a number of inflammatory dermatoses and its good safety profile. Although the pathogenic role of topical calcineurin inhibitors remains to be elucidated, this rare cutaneous adverse event should be recognized by dermatologists.