facial dermatoses
DESCRIPTION
Facial dermatoses. 25 interactive case reports. Daniel Wallach, MD Senior lecturer, Tarnier Hospital Paris. Facial dermatoses: general data. High frequency All dermatological diagnoses can be met Location is crucial in psychological-social consequences (quality of life) - PowerPoint PPT PresentationTRANSCRIPT
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Facial dermatoses
25 interactive case reports
Daniel Wallach, MDSenior lecturer,
Tarnier Hospital Paris
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Facial dermatoses: general data
• High frequency
• All dermatological diagnoses can be met
• Location is crucial in psychological-social
consequences (quality of life)
• Parcimonious biopsies
• Worsening role of sun exposure
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Case # 1
• 32-year-old woman, florist
– Has suffered from erythematous dermatitis flare-ups on the face for several years
– Treated more or less successfully with potent topical steroids
– Generally consults when flare-ups occur
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What is your diagnosis?
A – Lupus erythematosus
B – Contact dermatitis
C – Atopic dermatitis
D – Contact photoallergy
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What is your diagnosis?
A – Lupus erythematosus
B – Contact dermatitis
C – Atopic dermatitis
D – Contact photoallergy
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Atopic dermatitis in adults
• Persistent AD, with flare-ups during stressful situations– or rarely newly-onset : make sure of diagnosis
• Includes severe forms, risks of complication, therapeutic difficulties
• A particular form predominates on the head and neck. – Were incriminated :
• photosensitization (phenothiazines)• airborne contact allergens• Malassezia
– A good indication for topical tacrolimus
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Atopic dermatitis in adults
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Case # 2
• 46-year-old man
• No relevant medical history
• Plaques on the nose for the past six months
• Unsuccessfully treated with tetracyclines
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What is your diagnosis?
A – Rosacea
B – Lupus erythematosus
C – Lymphoma
D – Sarcoidosis
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A biopsy was performed
Well-defined nodules of epithelioid cells, surrounded by a
lymphocytic ring
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What is your diagnosis?
A – Rosacea
B – Lupus erythematosus
C – Lymphoma
D – Sarcoidosis
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Another case of « plaque »cutaneous sarcoidosis
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Polymorphism of cutaneous sarcoidosis
• Small smooth, pinkish-red nodules
• Large nodules, with lupoid infiltrate
• More diffuse infiltrates
– Lupus perniosis (chilblain lupus, chilblain-like
BBS)
• Hypodermic Nodules, ulcerations,
erythroderma, granulomas on scars, …
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Summary: sarcoidosis
• Adenopathies– Mediastinal– Others
• Pulmonary parenchyma – Micronodules– Macronodules– Diffuse infiltrates – Pulmonary fibrosis, emphysema
• Other locations:– Eyes, salivary glands, bones, nerves, …. (all organs)
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Treatment for cutaneous sarcoidosis
• Only systemic steroids (one to two years) are truly effective
• Although they are difficult to prescribe in isolated cutaneous lesions
• Facial involvement may represent an indication• Other treatments:
– Topical or intralesional steroifs– Cryotherapy – Anti-malarials– Methotrexate.
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Case # 3
• 64-year-old man • Hypertensive• Treated for lung cancer • Consults for a recent pustular eruption of the
face and trunk
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What is your diagnosis?
A. Late-onset acne
B. Pustular rosacea
C. Adverse drug reaction
D. Pustular psoriasis
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What is your diagnosis?
A. Late-onset acne
B. Pustular rosacea
C. Adverse drug reaction
D. Pustular psoriasis
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Acneiform eruption due to gefitinib
• Inhibitor of EGF receptor tyrosine kinase (Receptor of the Epidermal Growth Factor, involved in
tumoral growth)
• Used in numerous types of advanced cancers (notably non-small cell lung cancers)
• Well-tolerated, apart from cutaneous side-effects which may be correlated with the treatment’s effectiveness. – Often : acneiform or rosacea-like eruption– Rare : xerosis, eczematiform eruption, telangiectasias,
hyperpigmentations, paronychias, pyogenic granulomas
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Case # 4
• 33-year-old woman,
• Teacher,
• No relevant medical history,
• Treated for several months with tetracyclines, unsuccessfully, for an acneiform pruriginous eruption on the face
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Close-up:
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What is your diagnosis?
A. « Adult » acne
B. Rosacea
C. Demodecidosis
D. Sarcoidosis
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What is your diagnosis?
A. « Adult » acne
B. Rosacea
C. Demodecidosis
D. Sarcoidosis
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How to diagnose demodecidosis?
• Rosacea-like erythema and papules
• Without true rosacea features
• Pruritus
• « Rough » skin
• Rapid and clear response with an antiparasitic
treatment (crotamiton, lindane)
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If a biopsy were performed
The presence of Demodex in the follicles is not pathognomonic of demodecidosis, and is less valuable than the successful tested treatment.
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Another case of demodecidosis
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Case # 5
• 72-year old woman, rushed to hospital for severe deterioration of her general state of health,
• High fever,
• facial eruption.
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What is your diagnosis?
A. Necrotizing fasciitis
B. Malignant staphylococcal infection
C. Sweet’s syndrome
D. Mucormycosis
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What is your diagnosis?
A. Necrotizing fasciitis
B. Malignant staphylococcal infection
C. Sweet’s syndrome
D. Mucormycosis
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Sweet’s syndrome
• Belongs to the group of theneutrophilic dermatoses
• is paraneoplastic in 30% of cases (leukemias, …)
• Is very sensitive to systemic steroids
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Histopathology of Sweet’s syndrome
Neutrophilic infiltrate of the superficial dermis, edema of the dermal papilla
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Sweet’s syndrome frequently involves the face
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Case # 6
• 62-year-old man,
• No relevant medical history,
• Consults for scaly lesions on the mediofacial area, present for about a year
• Several topical antifungal treatments have been tested, with no improvement
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What is your diagnosis?
A. Seborrheic dermatitis
B. Psoriasis
C. Superficial pemphigus
D. Bazex syndrome
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What is your diagnosis?
A. Seborrheic dermatitis
B. Psoriasis
C. Superficial pemphigus
D. Bazex syndrome
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Seborrheic pemphigus, or Pemphigus erythematosus, or Senear – Usher syndrome
• Belongs to the group of superficial pemphigus
• Affects seborrheic facial areas
• Spares mucous membranes
• Nikolski’s sign is present
• No to be mistaken for seborrheic dermatits or lupus
erythematosus
• May be sensitive to : – Topical steroids
– Disulone
– Low-dose systemic steroids
One case of pemphigus vulgaris involving the face
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Biopsy is essential
Superficial intra-epidermic blister, discrete acantholysisIFD : intercellular IgG and C3 depositsWB, ELISA : anti-desmoglein 1 auto-antibodies (160 kD)
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Case # 7
• 32-year-old woman, general practicioner
• No relevant medical history,
• Has had a lesion on the nose for two months
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What is your diagnosis?
A. Benign cutaneous lymphocytoma
B. Sarcoidosis
C. Lupus erythematosus
D. Facial granuloma
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We decided to perform a biopsy
Dense and polymorphous dermal infiltrate.
Numerous clearly visible eosinophils (formol)Integrity of follicles
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What is your diagnosis?
A. Benign cutaneous lymphocytoma
B. Sarcoidosis
C. Lupus Erythematosus
D. Facial granuloma
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Facial granuloma
• Sometimes called « eosinophilic grabuloma »
• Described by Lever
• Often solitary, reddish-brown plaque
• Nose (+++), forehead, cheeks
• The « orange skin » aspect is characteristic
• Treatment is difficult treatment (beware of scars!).
Try dapsone
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Case # 8
• 36-year-old man
• No medical history
• Has had for the past two months a firm and painless tumefaction on the forehead
• Which we recently biopsied.
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What is your diagnosis?
A. Lymphoma
B. Dermatofibrosarcoma
C. Sub-aponeurotic lipoma
D. Granuloma Annulare
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Areas of of dermal degeneration surrounded by a lympho-histiocytic granuloma, sometimes palissadic with epithelioid cells Elastic fibers are normal.
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What is your diagnosis?
A. Lymphoma
B. Dermatofibrosarcoma
C. Sub-aponeurotic lipoma
D. Granuloma annulae
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Granuloma annulare profundus
• Superficial (pink papules) or deep (raising the skin)• Limited or extensive • Limbs or face• Children or adults• …• The granuloma is never pruriginous nor painful, • Its cause in unknown, • And no treatment is effective.
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Case # 9
• 42-year-old woman
• Seen at the Emergency Room for a facial eruption,
• Developing for ten days,
• Non-pruriginous
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What is your diagnosis?
A. Drug rash
B. Secondary syphilis
C. Erythema multiforme
D. HIV primo-infection
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What is your diagnosis?
A. Toxidermia
B. Secondary syphilis
C. Polymorphous erythema
D. HIV primo-infection
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Secondary syphilis
• Still exists
• Even if it is now mainly frequent in HIV high risk groups (think of
other STDs)
• Is still as « simulator »
• Is confirmed by serology
• Can be efficiently treated with penicillin
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A case of acneiform secondary syphilis
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Case # 10
• 72-year-old man
• Former monk in Vietnam
• Medical history : malaria, amebiasis
• Consults for a diffuse nodular eruption which has gradually appeared in the past two months
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What is your diagnosis?
A. Myeloid leukemia
B. B-Lymphoma
C. Hansen’s disease
D. Sarcoidosis
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What is your diagnosis?
A. Myeloid leukemia
B. B-Lymphoma
C. Hansen’s disease
D. Sarcoidosis
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Histiocytic infiltrate, involves the nerves,
positive Ziehl’s staining
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Hansen’s disease (leprosy)
• Think of it for patients having lived in endemic countries
• Perform the diagnostic tests– Biopsy with Ziehl’s stain
– Cutaneous and neurological examination
– Bacteriology
• Treat– According to WHO recommendations
• Manage the psychological and social component (don’t overdramatize)
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Case # 11
• 33-year-old woman
• Consulting for an eruption on the eyelids
• Occurred following exposure to the sun
• Non-pruriginous
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What is your diagnosis?
A. Lupus erythematosus
B. Contact dermatitis
C. Polymorphous light eruption
D. Dermatomyositis
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What is your diagnosis?
A. Lupus erythematosus
B. Contact dermatitis
C. Polymorphous light eruption
D. Dermatomyositis
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Allergens of facial contact dermatitis
• Cosmetics (fragrances, preservatives, sunscreens,
others…)
• Topical drugs
• Airborne allergens
• Photoallergens
• + nail polish, jewellery, ….
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Facial eczemas Anti-herpes gel
Eye drops
HexamidineDay cream
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The importance of patch tests
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Case # 12
• 18-year old girl
• Treated for acne for two years, with oral tetracyclines and topicals
• Wishes to have a second opinion before taking oral isotretinoin
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What is your diagnosis?
A. Acne resistant to tetracyclines, a good indication for isotretinoin
B. Gram negative folliculitis
C. Excoriated acne
D. This is not acne
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What is your diagnosis?
A. Acne resistant to tetracyclines, a good indication for isotretinoin
B. Gram negative folliculitis
C. Excoriated acne
D. This is not acne
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Excoriated acne « des jeunes filles »
• Often seen in women, but not always in « young » patients
• Belongs to the so-called “psychodermatoses”, generally managed by dermatologists
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Case # 13
• 41-year-old man
• With an eruption on the eyelids
• Has been progressing in flare-ups for several years
• Sensitive to topical steroids
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What is your diagnosis?
1. Atopic dermatitis
2. Contact dermatitis
3. Peri-ocular dermatitis
4. Psoriasis
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What is your diagnosis?
1. Atopic dermatitis
2. Contact eczema
3. Peri-ocular dermatitis
4. Psoriasis
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Facial psoriasis
• Relatively rare• Often « seborrheic »
– Involves the scalp, the ears
• Often « classic »• Rarely hyperkeratotic
• A good indication (off-label) for topical tacrolimus
![Page 86: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/86.jpg)
Facial psoriasis
![Page 87: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/87.jpg)
Case #14
• 38-year-old man
• Undergoing treatment for acute myeloblastic leukemia
• Sudden eruption on the face
![Page 88: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/88.jpg)
![Page 89: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/89.jpg)
What is your diagnosis?
1. Adverse reaction to chemotherapy
2. Cellulitis
3. Sweet’s syndrome
4. Neutrophilic eccrine hidradenitis
![Page 90: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/90.jpg)
Neutrophilic infiltrate in contact with the eccerine glands and ducts.
Here, no necrosis or malpighian metaplasia
![Page 91: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/91.jpg)
What is your diagnosis?
1. Adverse reaction to chemotherapy
2. Cellulitis
1. Sweet’s syndrome
2. Neutrophilic eccrine hidradenitis
![Page 92: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/92.jpg)
Neutrophilic eccrine hidradenitis
• Belongs to the spectrum of the neutrophilic dermatoses
• Clinically resembles Sweet’s syndrome
• Histologically includes a neutrophilic infiltrate exclusively localized in and around
the eccrine glands and ducts
• Generally occurs in leukemic patients treated with cytarabine
• A benign palmoplantar variant exists in children.
![Page 93: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/93.jpg)
Case #15
• 6-year-old child,
• In good health
• With plaques on the face following sun exposure
![Page 94: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/94.jpg)
![Page 95: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/95.jpg)
What is your diagnosis?
1. Lupus erythematosus
2. Benign solar eruption
3. Polymorphous light eruption
4. Erythema multiforme
![Page 96: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/96.jpg)
What is your diagnosis?
1. Lupus erythematosus
2. Benign solar eruption
3. Polymorphous light eruption
4. Erythema multiforme
![Page 97: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/97.jpg)
Polymorphous light eruption
• Differential Diagnosis: – Drug-induced photosensitivity– Lupus erythematosus (PLE may precede)– Contact photoallergy
• Generally intense• Several clinical (pseudo-urticaria, lichen, lupus, erythema
multiforme, prurigo, eczema). • Pruritus is constant • Histology : eczematous• Phototests : Repeated polychromatic test positive
![Page 98: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/98.jpg)
Papular polymorphous light eruption
![Page 99: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/99.jpg)
Case #16
• 76-year-old woman,
• Diabetes, hypertension
• Consulting for an eruption on the face and forearms which appeared in June 2005.
![Page 100: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/100.jpg)
![Page 101: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/101.jpg)
What is your diagnosis?
1. Erythroderma
2. Psoriasis
3. Photosensitization
4. Eczema
![Page 102: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/102.jpg)
What is your diagnosis?
1. Erythroderma
2. Psoriasis
3. Photosensitization
4. Eczema
![Page 103: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/103.jpg)
Photosensitizing drugs
AntibioticsTetracyclines, fluoroquinolones, nalidixic acid, ceftazidime, sulfonamides, isoniazid, pyrazinamide
Other anti-infectiousGriseofulvin, ketoconazole
NSAIDIbuprofene, naproxene, and other by-products of arylpropionic acid, Phenylbutazone, oxyphenbutazone, mefenamic acid, meclofenamic acid, Piroxicam, diclofenac
DiureticsHydrochlorothiazide, bendroflumethiazide, furosemide
RetinoidsIsotretinoin, acitretin
Antimitotics5-fluoro uracile, dacarbazine, methotrexate, vinblastine
PsychotropicsAntidepressant tricyclics, Phenothiazines, Carbamazepine
MiscellaneousAmiodarone, diltiazem, quinidine, capatopril, ….
![Page 104: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/104.jpg)
Case #17
• 15-year-old girl
• Consulting for skin eruption – Initially thought to be a sunburn– But which persisted after several weeks
![Page 105: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/105.jpg)
![Page 106: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/106.jpg)
What is your diagnosis?
1. Lupus erythematosus
2. Persistent photodermatitis
3. Photosensitization
4. Dermatomyositis
![Page 107: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/107.jpg)
What is your diagnosis?
1. Lupus erythematosus
2. Persistent photodermatitis
3. Photosensitization
4. Dermatomyositis
![Page 108: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/108.jpg)
Cutaneous forms of lupus erythematosus
• Lupus may be – Chronic cutaneous– Disseminated cutaneous– Subacute– Acute, systemic
• Therefore, adequate, simple workup is mandatory
![Page 109: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/109.jpg)
Workup of a patient d’un patient in whom lupus is suspected
• Confirm diagnosis– Cutaneous biopsy, IF if possible
• Assess the lupus disease – Clinical examination– Warning signs towards another lupus localization – Blood biology, urinary biology– anti-nuclear antibodies, typing– Complement
• General examination– Medical history– Risk of drug interactions
![Page 110: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/110.jpg)
Cutaneous LE
![Page 111: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/111.jpg)
Cutaneous LE
![Page 112: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/112.jpg)
Cutaneous LE
![Page 113: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/113.jpg)
Cutaneous LE
![Page 114: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/114.jpg)
Case # 18
• 21-year-old man, baker,
• Consulting for circinate lesions on the face, present for about fifteen days
![Page 115: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/115.jpg)
![Page 116: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/116.jpg)
What is your diagnosis?
1. Pityriasis rosea
2. Erythema multiforme
3. Dermatophyosis
4. Psoriasis
![Page 117: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/117.jpg)
What is your diagnosis?
1. Pityriasis rosea
2. Erythema multiforme
3. Dermatophyosis
4. Psoriasis
![Page 118: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/118.jpg)
No comment.
we had to think about it, and carry a mycologic sample
And treat his cat!
![Page 119: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/119.jpg)
Case # 19
• 28-year-old man, no medical history
• Consults for persistent « sunburn » on the face
![Page 120: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/120.jpg)
![Page 121: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/121.jpg)
What is your diagnosis?
1. Lupus erythematosus
2. Persistent light eruption
3. Photosensitization
4. Dermatomyositis
![Page 122: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/122.jpg)
What is your diagnosis?
1. Lupus erythematosus
2. Persistent light eruption
3. Photosensitization
4. Dermatomyositis
![Page 123: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/123.jpg)
Cutaneous signs of dermatomyositis
• Heliotrope erythema
• Similar to Light Eruption, but: • More pinkish, violaceous• Predominates on the eyelids and back of the hands
– sometimes edematous
• Poikiloderma, at a later stage
![Page 124: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/124.jpg)
In case of cutaneous dermatomyositis
• Assess the muscular involvement
• Search for concomitant cancer (20% of DM in adults)
• Treat (difficult)
![Page 125: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/125.jpg)
Hydrea-induced pseudo-dermatomyositis
![Page 126: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/126.jpg)
Case # 20
• 26-year-old woman
• Treated for several years for seborrheic dermatitis
• Worsening and progressive extension
![Page 127: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/127.jpg)
![Page 128: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/128.jpg)
What is your diagnosis?
1. Seborrheic dermatitis
2. Perioral dermatitis
3. Adult acne
4. Sarcoidosis
![Page 129: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/129.jpg)
What is your diagnosis?
1. Seborrheic dermatitis
2. Perioral dermatitis
3. Adult acne
4. Sarcoidosis
![Page 130: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/130.jpg)
Perioral dermatitis is an inflammatory reaction that is
poorly understood, often caused by topical steroids, even at low
doses.
![Page 131: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/131.jpg)
Case # 21
• 45-year-old man
• With plaques on the face
• Triggered by emotional stress
![Page 132: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/132.jpg)
![Page 133: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/133.jpg)
What is your diagnosis?
1. Lupus erythematosus
2. Seborrheic dermatitis
3. Psoriasis
4. Photosensitization
![Page 134: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/134.jpg)
What is your diagnosis?
1. Lupus erythematosus
2. Seborrheic dermatitis
3. Psoriasis
4. Photosensitization
![Page 135: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/135.jpg)
Seborrheic dermatitis
• The most frequent skin condition
• Often clearly related to stress
• Located in areas rich in sebaceous glands
– Mid-facial area, scalp, mid-trunk
• A psoriasiform inflammation (erythema, desquamation) promoted by the
presence of Malassezias
• Improvement with antifungals (ketoconazole, ciclopiroxolamine)
• Severe forms justify short, controlled, low-dose topical steroid therapy.
![Page 136: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/136.jpg)
Case # 22
• 48-year-old woman
• Has had small blemishes on her face for several years
• Treated for acne, unsuccessfully
![Page 137: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/137.jpg)
![Page 138: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/138.jpg)
What is your diagnosis?
1. Acne
2. Sarcoidosis
3. Tuberculide
4. Lupus miliaris faciei
![Page 139: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/139.jpg)
Epithelioid granuloma with giant cells
Caseous central necrosis
![Page 140: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/140.jpg)
What is your diagnosis?
1. Acne
2. Sarcoidosis
3. Tuberculide
4. Lupus miliaris faciei
![Page 141: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/141.jpg)
Lupus miliaris disseminated on the face
• Brown-red papules, 1-3mm
• Over the entire face (mid-facial area, eyelids)
• Evolves into scars
• No other symptom
• No clear link with : – Tuberculosis
– Sarcoidosis
– Acne
– …
• Treatment : dapsone / topical steroids
![Page 142: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/142.jpg)
Two recently published cases(Bohran R, Vignon-Pennamen MD, Morel P, Ann Dermatol 2005)
![Page 143: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/143.jpg)
Case # 23
• 20-year-old girl
• Sudden ocular eruption
• Fever 38°2 C, lymph node enlargement
![Page 144: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/144.jpg)
![Page 145: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/145.jpg)
What is your diagnosis?
1. Sweet’s Syndrome
2. Erysipelas
3. Malignant staphylococcal infection
4. Insect bite
![Page 146: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/146.jpg)
What is your diagnosis?
1. Sweet’s Syndrome
2. Erysipelas
3. Malignant staphylococcal infection
4. Insect bite
![Page 147: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/147.jpg)
Erysipelas
• Streptococcal dermatitis
• Often without warning sign nor identifiable portal of entry
• Often with systemic symptoms
• Rarely bacteriologically proven
• But needs to be treated rapidly (penicillin G, or amoxicillin or oral macrolide)
![Page 148: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/148.jpg)
Case #24
• 32-year-old man
• Moderate atopic dermatitis since childhood
• Sudden facial eruption
![Page 149: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/149.jpg)
![Page 150: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/150.jpg)
What is your diagnosis?
1. Secondary superinfection of atopic dermatitis
2. Chicken pox
3. Eczema herpeticum
4. Molluscum contagiosum
![Page 151: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/151.jpg)
What is your diagnosis?
1. Secondary superinfection of atopic dermatitis
2. Chicken pox
3. Eczema herpeticum
4. Molluscum contagiosum
![Page 152: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/152.jpg)
Eczem herpeticum (Kaposi-Juliusberg’s varicelliform eruption)
• Corresponds to an herpetic primo-infection on a
preexisting dermatosis, usually atopic dermatitis
• Varicella- or smallpox-like vesicles-pustules
• Possible complications
• Currently of favorable outcomes (anti-virals)
![Page 153: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/153.jpg)
Case # 25
• 5-year-old child
• Always had « rosy cheeks »
• Treated for atopic dermatitis, unsuccessfully
![Page 154: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/154.jpg)
![Page 155: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/155.jpg)
What is your diagnosis?
1. Atopic dermatitis
2. Lupus erythematosus
3. Keratosis pilaris
4. Congenital erythroderma
![Page 156: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/156.jpg)
What is your diagnosis?
1. Atopic dermatitis
2. Lupus erythematosus
3. Keratosis pilaris
4. Congenital erythroderma
![Page 157: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/157.jpg)
Keratosis pilaris
• Simple– Arms and thighs – Visible in children, will improve with age
• Red, atrophic– Permanent erythema on the cheeks, « rough » to palpation– May involve the eyebrows, the ears
• Spinulosic, decalvant (causes baldness)
• No efficient treatment
![Page 158: Facial dermatoses](https://reader033.vdocuments.us/reader033/viewer/2022061520/56814299550346895daecc4d/html5/thumbnails/158.jpg)
Facial dermatoses
25 interactive case reports
Daniel Wallach, MD
Senior lecturerTarnier Hospital
Paris
Special thanks: MD Vignon-Pennamen, MDhttp://atlases.muni.cz/_atlas-top-cont-5up.html