Acta Dermato-Venereologica 99-6CompleteContent | Page 28

625 Disseminated Small Papules on the Face: A Quiz Victor OLSAVSZKY 1 , Cyrill GÉRAUD 1–3 and Moritz FELCHT 1,3 * 1 Department of Dermatology, Venereology, and Allergology, University Medical Center and Medical Faculty Mannheim, Heidelberg University, and Center of Excellence in Dermatology, Mannheim, 2 Section of Clinical and Molecular Dermatology, Medical Faculty Mannheim, Heidelberg University, Mannheim, and 3 European Center for Angioscience, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. *E- mail: [email protected] A woman in her 40s presented to our outpatient department with progressive facial skin lesions that had appeared 7 years earlier. She had also experienced loss of eyebrow hair and recession of the frontoparietal hairline 3˗4 years ago. She had numerous disseminated, non-confluent, pinhead- sized, skin-coloured papules on the cheeks, infraorbital and perioral regions (Fig. 1a, b). Her anterior and temporal hairline was visibly receding, revealing discrete keratotic follicular papules on the forehead (Fig. 1c). Her eyebrows had been cosmetically tattooed with permanent make-up. A 9-month treatment with topical and oral isotretinoin led to a significant improvement in the facial lesions, but tre- atment was discontinued due to elevated liver enzymes and epistaxis. The patient also reported itching of the papules for the last 2 weeks. Skin biopsies were taken from the left orbital region and the right temple (Fig. 2). Fig. 1. (a, b) Close-up of the papules on (a) infraorbital and (b) perioral regions. (c) Receding frontoparietal hairline with keratotic follicular papules on the frontal line. Eyebrow hair loss concealed by permanent make-up. Fig. 2. Haematoxylin-eosin stained skin biopsy specimen. Left: comedo- like hyperkeratosis. Right: follicular interface dermatitis of a vellus hair. (Scale bar: 100 μm). What is your diagnosis? See next page for answer. QUIZ SECTION This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica. doi: 10.2340/00015555-3146 Acta Derm Venereol 2019; 99: 625–626