Facial “acne” that has been present for entire life

Presenter: Chris Hixon, DO
Dermatology Program: Lewis Gale Hospital Montgomery
Program Director: Daniel Hurd, DO, FAOCD
Submitted on: Dec 3, 2013

CHIEF COMPLAINT:  23 yo Caucasian female presenting with facial “acne” that has been present her entire life.

CLINICAL HISTORY:

Signs and symptoms:  23 yo female that presented to our Dermatology clinic for the treatment of worsening facial “acne” that she has had her entire life. On initial visit this patient was found to have diffuse closed comedones and flesh colored papules involving her forehead and lateral cheeks. There were also areas of “ice pick” and atrophic scarring as well as focal post inflammatory hyperpigmentation (PIH).

Previous Treatment:  OTC clean and clear black head eraser
Tazorac 0.05% cream qhs
Minocycline 100mg QD
Doxycycline 150mg QD
Tretinoin 0.025% cream qhs

Other information:  Dermatological history: Acne in both the patient and her father
Medical history : No chronic medical conditions
Family history: Seizures

PHYSICAL EXAM:

Skin exam revealed >50 closed comedones and > 50 flesh colored papules with the greatest concentration of both being on the forehead and cheeks. There was also focal involvement of the temples, chin and jawline. Randomly scattered foci of acne scarring and PIH were also noted.

LABORATORY TESTS:

None

DERMATOHISTOPATHOLOGY:

The cyst itself contains variable amounts of keratin as well as multiple transverse and obliquely cut vellus hairs.

DIFFERENTIAL DIAGNOSIS:

1.   Acne Vulgaris
2.   Steatocystoma Multiplex
3.   Milia
4.   Eruptive Vellus Hair Cysts
5.   Multiple Syringomas


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