DOCSLIB.ORG

Unmasking Four Potential Mimickers of Acne Or Rosacea

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Unmasking Four Potential Mimickers of Acne Or Rosacea [ Acne/Rosacea Advances] Unmasking Four Potential Mimickers of Acne or Rosacea Dermatologists usually diagnose the following conditions with ease, but patients may be convinced they have acne or rosacea. By Dina Anderson, MD ecause acne is so widespread, it necessary in rare instances. Topical patient manipulation or other trauma. is the average patient’s default skincare should include a soap-free Milia typically resolve on their own Bdiagnosis for any red, bumpy moisturizing cleanser and an oil-free with no intervention. Some may be facial skin condition. Many patients daily moisturizer containing sunscreens. persistent, or patients may request incorrectly believe that even rosacea is Perioraficial dermatitis. removal for cosmetic reasons. Topical simply “adult acne.” Sometimes considered a subtype of skin creams and cleansers are marketed Following is a look at some acne rosacea, this condition occurs frequent- but offer little benefit. The most expe- and/or rosacea mimickers and their ly in children but also occurs in women dient remedy for milia is extraction: treatment. Educating patients about the and men. Characterized by tiny inflam- Milia/Milium are treated by puncturing nature of these conditions and distin- matory papules, it occurs in a charac- the skin with a 30-gauge needle fol- guishing them from acne or rosacea teristic distribution around the orifices lowed by removal using a comedone may improve compliance and minimize of the face. Comedones are absent. extractor. Regular use of a topical the likelihood that patients will try to Periorificial dermatitis can look granu- retinoids, glycolic acid, or salicylic acid add-on “remedies” that may actually lomatous and is commonly misdiag- products may help to prevent recur- exacerbate their presentation. nosed as an allergic reaction when it rence of milia. Perioral Dermatitis. Derma- only occurs by the corners of the eye. Keratosis pilaris rubra faceii tologists are familiar with perioral der- Any of the topical agents commonly (KPRF). This variant of KP is character- matitis, which, as its name suggests, used for rosacea may treat this condi- ized by tiny, flesh-colored papules on a occurs around the mouth and may tion, however oral antibiotics may be background of erythema, often develop- involve the nasolabial folds. It is a pres- indicated. Maintain therapy for several ing during adolescence. The condition is entation exclusive to women. weeks and advise patients to be vigilant sometimes mistaken for acne or rosacea Sometimes mistaken for an allergic for signs of recurrence. Institution of by patients. Many affected individuals contact reaction, perioral dermatitis topical therapy at the first signs of are distressed by the highly visible pres- spares the vermillion; an allergic con- recurrence may hold a flare at bay. entation. tact reaction will not. Although not studied, anti-inflam- Treatment options are limited. KTP Inflammatory papules can be matory dose doxycycline (Oracea, or pulsed dye laser or IPL can help calmed with sulfur based topical for- CollaGenex) may be a reasonable sys- KPRF. Topical antioxidants can also mulations or masks. Oral tetracyclines temic option to manage recurrent or help diminish persistent erythema. represent the best treatment option for persistent perioraficial dermatitis. Typical topical acne therapies, like this condition. Many patients will have Milia. Milia on the face can be a retinoids and benzoyl peroxide, tend to attempted therapy with over-the-count- persistent and troubling presentation. irritate the condition. Topical therapies er remedies, sometimes including topi- Though not a form of acne, milia may containing lactic acid, glycolic acid, or cal corticosteroids. Improper therapies be mistaken for whiteheads by patients. salicylic acid can help improve texture may exacerbate inflammation or, in the They are common around the eye but and minimize the “bumpy” quality of case of corticosteroids, contribute to can occur at other sites. Though inflam- follicular spines. The same camouflage the presentation by inducing “steroid mation is not a component of the techniques used in rosacea (such as acne.” Patients must discontinue all pathogenesis of these tiny pockets of green-tinted make-up) will benefit inter- topical therapies. To avoid a vigorous sebum and keratinocytes trapped within ested patients. The condition seems to flare, tapering of the steroid may be the follicle, erythema may result from resolve as patients age. December 2007 Practical Dermatology 19.
Load more

Recommended publications
  • Multiple Asymptomatic Papules on the Back of the Right Side of the Chest Angoori Gnaneshwar Rao
    QUIZ Multiple Asymptomatic Papules on the Back of the Right Side of the Chest Angoori Gnaneshwar Rao A 43-year-old male presented with multiple asymptomatic complete blood picture, blood sugar, complete urine examination, papules on the back of the right side of the chest of 1 year blood urea, serum creatinine, liver function tests and serum duration. He was asymptomatic a year back then he developed lipid profile were normal. Fundus was normal. A slit skin smear small papules on the right side of the front of the chest initially for acid fast bacilli was negative. A punch biopsy from the and later on involved the front and back of the chest. No representative lesion subjected to histopathological examination history was suggestive of leprosy and hyperlipidemias. Family revealed a cyst with an intricately folded wall, lined by two to history was negative for similar problem. Examination revealed three layers of flattened squamous epithelium and the absence multiple skin-colored to yellowish papules distributed on the of the granular layer. Lobules of sebaceous glands were found front and back of the chest and shoulder region on the right embedded in cyst lining. The lumen was filled with amorphous side [Figure 1]. Also, there were multiple hyperpigmented eosinophilic material and multiple hair shafts [Figures 2-4]. macules on the right infrascapular region. There was no nerve thickening and no sensory deficit and there were no Question hypopigmented or anesthetic patches. Systemic examination did not reveal any abnormality. Routine investigations including What is your diagnosis? (Original) Multiple skin-colored to yellowish papules on the back of chest Figure 1: Figure 2: (Original) Histopathology of skin showing a cyst with an intricately folded and shoulder region on the right side wall lined by two to three layers of flattened squamous epithelium and the absence of granular layer.
    [Show full text]
  • 2016 Essentials of Dermatopathology Slide Library Handout Book
    2016 Essentials of Dermatopathology Slide Library Handout Book April 8-10, 2016 JW Marriott Houston Downtown Houston, TX USA CASE #01 -- SLIDE #01 Diagnosis: Nodular fasciitis Case Summary: 12 year old male with a rapidly growing temple mass. Present for 4 weeks. Nodular fasciitis is a self-limited pseudosarcomatous proliferation that may cause clinical alarm due to its rapid growth. It is most common in young adults but occurs across a wide age range. This lesion is typically 3-5 cm and composed of bland fibroblasts and myofibroblasts without significant cytologic atypia arranged in a loose storiform pattern with areas of extravasated red blood cells. Mitoses may be numerous, but atypical mitotic figures are absent. Nodular fasciitis is a benign process, and recurrence is very rare (1%). Recent work has shown that the MYH9-USP6 gene fusion is present in approximately 90% of cases, and molecular techniques to show USP6 gene rearrangement may be a helpful ancillary tool in difficult cases or on small biopsy samples. Weiss SW, Goldblum JR. Enzinger and Weiss’s Soft Tissue Tumors, 5th edition. Mosby Elsevier. 2008. Erickson-Johnson MR, Chou MM, Evers BR, Roth CW, Seys AR, Jin L, Ye Y, Lau AW, Wang X, Oliveira AM. Nodular fasciitis: a novel model of transient neoplasia induced by MYH9-USP6 gene fusion. Lab Invest. 2011 Oct;91(10):1427-33. Amary MF, Ye H, Berisha F, Tirabosco R, Presneau N, Flanagan AM. Detection of USP6 gene rearrangement in nodular fasciitis: an important diagnostic tool. Virchows Arch. 2013 Jul;463(1):97-8. CONTRIBUTED BY KAREN FRITCHIE, MD 1 CASE #02 -- SLIDE #02 Diagnosis: Cellular fibrous histiocytoma Case Summary: 12 year old female with wrist mass.
    [Show full text]
  • Differential Diagnosis of the Scalp Hair Folliculitis
    Acta Clin Croat 2011; 50:395-402 Review DIFFERENTIAL DIAGNOSIS OF THE SCALP HAIR FOLLICULITIS Liborija Lugović-Mihić1, Freja Barišić2, Vedrana Bulat1, Marija Buljan1, Mirna Šitum1, Lada Bradić1 and Josip Mihić3 1University Department of Dermatovenereology, 2University Department of Ophthalmology, Sestre milosrdnice University Hospital Center, Zagreb; 3Department of Neurosurgery, Dr Josip Benčević General Hospital, Slavonski Brod, Croatia SUMMARY – Scalp hair folliculitis is a relatively common condition in dermatological practice and a major diagnostic and therapeutic challenge due to the lack of exact guidelines. Generally, inflammatory diseases of the pilosebaceous follicle of the scalp most often manifest as folliculitis. There are numerous infective agents that may cause folliculitis, including bacteria, viruses and fungi, as well as many noninfective causes. Several noninfectious diseases may present as scalp hair folli- culitis, such as folliculitis decalvans capillitii, perifolliculitis capitis abscendens et suffodiens, erosive pustular dermatitis, lichen planopilaris, eosinophilic pustular folliculitis, etc. The classification of folliculitis is both confusing and controversial. There are many different forms of folliculitis and se- veral classifications. According to the considerable variability of histologic findings, there are three groups of folliculitis: infectious folliculitis, noninfectious folliculitis and perifolliculitis. The diagno- sis of folliculitis occasionally requires histologic confirmation and cannot be based
    [Show full text]
  • A Deep Learning System for Differential Diagnosis of Skin Diseases
    A deep learning system for differential diagnosis of skin diseases 1 1 1 1 1 1,2 † Yuan Liu ,​ Ayush Jain ,​ Clara Eng ,​ David H. Way ,​ Kang Lee ,​ Peggy Bui ,​ Kimberly Kanada ,​ ​ ​ ‡ ​ 1​ ​ 1 ​ 1 ​ Guilherme de Oliveira Marinho ,​ Jessica Gallegos ,​ Sara Gabriele ,​ Vishakha Gupta ,​ Nalini 1,3,§ 1 ​ ​ 4 ​ 1 ​ ​ 1 Singh ,​ Vivek Natarajan ,​ Rainer Hofmann-Wellenhof ,​ Greg S. Corrado ,​ Lily H. Peng ,​ Dale ​ ​ 1 1 ​ † 1, ​ 1, ​ 1, ​ R. Webster ,​ Dennis Ai ,​ Susan Huang ,​ Yun Liu *​ , R. Carter Dunn *​ *, David Coz *​ * ​ ​ ​ ​ ​ ​ Affiliations: 1 G​ oogle Health, Palo Alto, CA, USA 2 U​ niversity of California, San Francisco, CA, USA 3 M​ assachusetts Institute of Technology, Cambridge, MA, USA 4 M​ edical University of Graz, Graz, Austria † W​ ork done at Google Health via Advanced Clinical. ‡ W​ ork done at Google Health via Adecco Staffing. § W​ ork done at Google Health. *Corresponding author: [email protected] **These authors contributed equally to this work. Abstract Skin and subcutaneous conditions affect an estimated 1.9 billion people at any given time and remain the fourth leading cause of non-fatal disease burden worldwide. Access to dermatology care is limited due to a shortage of dermatologists, causing long wait times and leading patients to seek dermatologic care from general practitioners. However, the diagnostic accuracy of general practitioners has been reported to be only 0.24-0.70 (compared to 0.77-0.96 for dermatologists), resulting in over- and ​ ​ ​ ​ ​ ​ ​ under-referrals, delays in care, and errors in diagnosis and treatment. In this paper, we developed a deep learning system (DLS) to provide a differential diagnosis of skin conditions for clinical cases (skin photographs and associated medical histories).
    [Show full text]
  • The Comparison of Blood Lipid Profile in Patients with and Without Androgenetic Alopecia
    ORIGINAL ARTICLE DOI: 10.4274/jtad.galenos.2020.76486 J Turk Acad Dermatol 2020;14(1):12-18 The Comparison of Blood Lipid Profile in Patients with and Without Androgenetic Alopecia Tuğba Akın, Zekayi Kutlubay, Özge Aşkın Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Dermatology, Istanbul, Turkey ABSTRACT Background: Androgenetic alopecia (AGA) is the most common cause of hair loss in both sexes. In several studies investigating the relationship between AGA and dyslipidemia, conflicting results have been reported. In this study, we aimed to compare serum triglyceride (TG) and high- density lipoprotein (HDL) cholesterol levels that one of the criteria of metabolic syndrome in male patients with and without AGA. Materials and Methods: The study group was consisted of 40 patients who had 2 and higher AGA. The control group was consisted of 40 patients aged who had no AGA at the clinical examination or who had stage 1 AGA. Fasting serum TG and HDL cholesterol levels were compared between study and control groups. Results: The mean serum TG values in the study group were 89.60; the mean serum TG values in the control group were 85.40. There was no statistical difference in serum TG values between the two groups (p<0.005). The number of patients with serum TG value ≥150 mg/dL was 5 (12.5%) in the study group and 3 (7.5%) in the control group; however, this difference was not statistically significant too (p<0.005). Mean serum HDL cholesterol levels in the study group were 52.67; the mean serum HDL cholesterol values in the control group were 52.62.
    [Show full text]
  • Systemic Sclerosis: a Case Study
    DERMATOLOGY OFFICE PLANNING: RADIO FREQUENCY FROM DESICCATORS TURNING ON AUTOMATIC FAUCETS AND TOWEL DISPENSERS Jonathan S. Crane, D.O., F.A.O.C.D.,* Christine Cook, BS,* David George Jackson, BS, ** Pete Buskirk, P.E.,*** Erin Griffin, DO, PGY 2**** *Atlantic Dermatology Associates, P.A., Wilmington, NC **University of North Carolina at Wilmington, Wilmington, NC ***Lee Cowper Construction, Wilmington, NC **** New Hanover Regional Medical Center, Wilmington, NC ABSTRACT In opening our brand-new, 20,000 square-foot dermatology facility, we were excited to have the latest technology. We opted for hands-free faucets and hands-free towel dispensers so as to minimize disease spread. At first we were very excited about the new technology, until we discovered that electrodessication could trigger the water faucets and towel dispensers. This in turn wasted paper and soaked both employees and other equipment. It became so frustrating that we ended up replacing over 20 faucets throughout the office, moving back to the old, hand-operated technology. We don’t want others to make this same mistake. Introduction We used hands-free faucets provided by Delta manufacturer, and the hands-free paper-towel dispensers were Tork Intuition Hand Towel Dispensers. Both the faucets and the towel dispensers work by detecting infrared radiation instead of responding to touch. The infrared detectors in the faucets are powered via the wall outlet; the dispensers are powered with three D batteries.1,2 We soon found that both of these technologies would also be turned on when we used our AARON 900 desiccators, provided by Bovie Medical. These desiccators use “disposable dermal tips,” which serve the function of limiting the spread of disease, much like the sensors do.3 The radio frequency emitted by this machine is 550 kHz (5.5x105 Hz).
    [Show full text]
  • Heliotrope Rash • Myopathy (May Be Amyopathic) • Cuticular Dilated Capillary Loops • Malignancy (Ovarian, Breast, Lung) 2
    Goals and Objectives: Dermatomyositis • At the end of this lecture, the learner will be able to: • Skin Signs: • Work Up: 1. Identify benign growths of the face • Heliotrope rash • Myopathy (may be amyopathic) • Cuticular dilated capillary loops • Malignancy (ovarian, breast, lung) 2. Identify manifestations of collagen vascular disease on the face • Others: • Interstitial lung disease • Anti‐Jo1, Anti‐MDA5 3. Appreciate the difficulty in identifying lentigo maligna melanoma • Gottron’s papules • Mechanics hands • Tx: 4. Create a differential diagnosis of perioral, peri‐ocular, labial, and • Poikiloderma atrophicans vasculare • Prednisone malar lesions and rashes • Shawl sign • Hydroxychloroquine • V‐sign • Methotrexate 5. Implement basic treatment paradigms of common conditions, • Calcinosis cutis including acne, rosacea, and eczema • Scalp scaling • Mycophenolate mofetil • IVIg Heliotrope Rash Dermatomyositis ‐ heliotrope eyelids Heliotrope, the flower She is not wearing eyeshadow. Dermatomyositis Seborrheic Dermatitis Gottron’s papules & cuticular dilated capillary loops • Same etiology as psoriasis…BUT ALSO…. • Caused by Pityrosporum fungus • Signs: scaling and erythema of: • Brow • Paranasal gutters • Posterior auricular (behind ears) • Conchae of ears • Scalp (a.k.a. dandruff) • Chest • Worse in HIV • Treatment: ketoconazole 2%, pimecrolimus, hydrocortisone 1% melanoma Seborrheic Dermatitis Seborrheic Dermatitis in HIV Zinc Deficiency Perioral Dermatitis from Topical Steroids • Looks like a mix of acne and eczema • Acquired • DDx:
    [Show full text]
  • Common Newborn Rashes N
    n Common Newborn Rashes n Miliaria. Sometimes called “heat rash” or “prickly heat.” Many newborn babies develop temporary skin rashes. Some common ones include erythema Caused by plugging of the sweat glands. This rash usual- toxicum, milium, sebaceous hyperplasia, miliaria, ly appears when your baby is overheated, such as when and neonatal acne. These are harmless conditions dressed too warmly for the weather, in a humid environ- that generally go away with no treatment. Call our ment, or during a fever. office if your newborn has a rash that seems to be In newborns, the rash appears most often as very tiny causing itching or discomfort. blisters often on the back, neck, or face. The blisters break easily with mild pressure. More commonly in older children, the rash may look like small, red bumps or occasionally pustules. It most What kinds of rashes can occur often appears on the neck, forehead, or areas covered in newborns? by clothing. Newborns can develop a number of common rashes that No treatment is needed, except to keep the baby cooler are harmless and usually go away without treatment. How- and prevent overheating. ever, the doctor may still want to check the rash, just to be sure that the diagnosis is correct and the condition doesn’t Sebaceous hyperplasia. Caused by enlarged sweat glands. need treatment. Any rash that seems to be bothering your Rash looks like lots of small, yellow/white, smooth bumps. baby, or a rash that is accompanied by fever, should be chec- ked by the doctor. Most common on the nose, forehead, and upper lip.
    [Show full text]
  • Milia: a Review and Classification
    15 March 2005 Use of Articles in the Pachyonychia Congenita Bibliography The articles in the PC Bibliography may be restricted by copyright laws. These have been made available to you by PC Project for the exclusive use in teaching, scholar- ship or research regarding Pachyonychia Congenita. To the best of our understanding, in supplying this material to you we have followed the guidelines of Sec 107 regarding fair use of copyright materials. That section reads as follows: Sec. 107. - Limitations on exclusive rights: Fair use Notwithstanding the provisions of sections 106 and 106A, the fair use of a copyrighted work, including such use by reproduction in copies or phonorecords or by any other means specified by that section, for purposes such as criticism, comment, news reporting, teaching (including multiple copies for classroom use), scholarship, or research, is not an infringement of copyright. In determining whether the use made of a work in any particular case is a fair use the factors to be considered shall include - (1) the purpose and character of the use, including whether such use is of a commercial nature or is for nonprofit educational purposes; (2) the nature of the copyrighted work; (3) the amount and substantiality of the portion used in relation to the copyrighted work as a whole; and (4) the effect of the use upon the potential market for or value of the copyrighted work. The fact that a work is unpublished shall not itself bar a finding of fair use if such finding is made upon consideration of all the above factors.
    [Show full text]
  • Milia: a Review and Classification
    Milia: A review and classification David R. Berk, MD, and Susan J. Bayliss, MD Saint Louis, Missouri Milia are frequently encountered as a primary or secondary patient concern in pediatric and adult clinics, and in general or surgical dermatology practice. Nevertheless, there are few studies on the origin of milia and, to our knowledge, there is no previous comprehensive review of the subject. We review the various forms of milia, highlighting rare variants including genodermatosis-associated milia, and present an updated classification. ( J Am Acad Dermatol 2008;59:1050-63.) ilia (singular: milium) are small (generally # 3 mm) white, benign, superficial kerat- Abbreviations used: inous cysts. Histologically, they resemble APL: atrichia with papular lesions M BCNS: Basal cell nevus syndrome miniature infundibular cysts, containing walls of BDCS: Bazex-Dupre-Christol syndrome stratified squamous epithelium several layers thick BFH: basaloid follicular hamartoma with a granular cell layer (Fig 1). Although benign CK: cytokeratin EB: epidermolysis bullosa primary milia are commonly encountered in clinical EBS: epidermolysis bullosa simplex practice, milia also occur in a variety of other condi- EVHC: eruptive vellus hair cyst tions, many of which are rare. They may arise either GBFHS: generalized basaloid follicular hamartoma syndrome spontaneously (primary milia) or secondary to var- MEM: multiple eruptive milia ious processes (secondary milia), as few or many MEP: milia en plaque lesions, and isolated or associated with other clinical MUS: Marie-Unna hypotrichosis 1 OFDS: orofaciodigital syndrome findings. Hubler et al proposed dividing milia into OMIM: Online Mendelian Inheritance in Man primary, secondary, and ‘‘other’’ types, a classifica- PC: pachyonychia congenita tion that Wolfe and Gurevitch2 modified.
    [Show full text]
  • Clin Dermatol J 2017, 2(5): 000130
    Clinical Dermatology Open Access Journal ISSN: 2574-7800 Peculiarities of the Clinical Picture and the Course of Acne and Rosacea at the Detection of Demodex Mites Kubanov A, Gallyamova Y, Kravchenko A* Research Article Russian Medical Academy of Continuous Professional Education of the Ministry of Volume 2 Issue 3 Healthcare of the Russian Federation, Russia Received Date: August 08, 2017 Published Date: August 23, 2017 *Corresponding author: Kravchenko Anzhela, Russian Medical Academy of DOI: 10.23880/cdoaj16000130 Continuous Professional Education of the Ministry of Healthcare of the Russian Federation, 123995, 2/1 Barrikadnaya Street, Moscow, Russia, Tel: +44 7491814698; E-mail: [email protected] Abstract The article analyzes the clinical picture and course of acne and rosacea in patients with Demodex mites. The article presents the advantages of using the method of confocal laser scanning microscopy and the superiority of this method over the method of light microscopy of skin scrapings. It was found that Demodex mites complicate the course of acne and rosacea. Demodex folliculorum longus shows signs of parasitism, while Demodex folliculorum brevis is a saprophyte of facial skin. The severity of the disease does not depend on the quantitative load of the mites in the scraping. As an antiparasitic medication for the purpose of eliminating Demodex mites, it is recommended to use 7% metronidazole in the form of a gel or cream-gel (depending on skin type) for 20 days externally. Keywords: Dermatology life quality index; DLQI; Demodex mites; Demodex folliculorum longus; Demodex folliculorum brevis; Acne; Rosacea Introduction In connection with the growth of the social in 55-100% of cases, mites are detected, both in patients environment as a whole and the increase of individual with facial dermatoses, and in individuals who do not exactingness to one's own appearance, both among men have any clinical manifestations of dermatological and women, dermatoses of the face remain one of the diseases [3-5].
    [Show full text]
  • Scientific Approach to the Treatment of Acne Vulgaris
    Scientific approach to the treatment of acne vulgaris Acne vulgaris is a dermatosis which involves the pilosebaceous apparatus of the skin; namely, the sebaceous gland and hair follicle (Fig. 1). Wilma F. Bergfeld, M.D Clinically, the skin changes are those of increased Department of Dermatology numbers of comedones (blackheads), milia (white- Department of Pathology heads or closed comedones), inflammatory papulo- pustular lesions, cysts, and atrophic or hyper- trophic scars. These acne lesions are most fre- quently observed on the face and less frequently on the chest and back. This distribution follows the embryonic development of the sebaceous gland with the greater number of glands being distributed over the face and lesser number and smaller glands distributed over the scalp, chest, and trunk. Acneform lesions may involve other areas such as arms, legs, and intertriginous skin. Acne vulgaris has been associated with other dis- eases of the pilosebaceous apparatus such as seborrheic dermatitis of the face and scalp, dis- secting folliculitis of the scalp, and hidradenitis suppurativa predominately of the axilla and groin.1 Recognition and treatment of these asso- ciated entities result in concomitantly good re- sponse to therapy. The onset of acne vulgaris is usually associated with the increased androgen stimulation of the sebaceous follicle which occurs either prepuber- tally or at puberty. Acneform lesions develop in 277 Downloaded from www.ccjm.org on September 27, 2021. For personal use only. All other uses require permission. 278 Cleveland Clinic Quarterly Vol. 42, No. 1 SEBACEOUS FOLLICLE SEBACEOUS GLAND HAIR DERMIS PILOSEBACEOUS APPARATUS Fig. 1. Drawing shows pilosebaceous apparatus of the skin.
    [Show full text]