FACIAL DERMATOSES-2

By- DR. SUJATA MAURYA

LUPUS MILIARIS DISSEMINATUS
FACIEI
Clinical Features
• Clinically, it is characterized by discrete, multiple, asymptomatic,
monomorphic, erythematous to reddish-brown, dome-shaped
papules
• involving central area of the face, particularly periorbital area,
nasolabial folds, cheeks, and the perioral areas, in a symmetrical
distribution
• Clinical image of lupus
miliaris disseminatus faciei
shows
• multiple monomorphic,
erythematous to reddish-
brown, dome-shaped
papules on the face,
particularly on periorbital
area, nasolabial folds,
cheeks, and perioral areas
 Dermoscopic Features
• Dermoscopy shows reddish-brown background, multiple ill-defined,
discrete, perifollicular, yellow to brown, structureless areas, which
represent granulomas.
• White or yellow keratotic follicular plugs and perifollicular scales are
seen.
• Keratotic follicular plugs on dermoscopy are secondary to the follicular
hyperkeratosis and lateral pressure on follicles by the surrounding
granulomas.
• Well-focused linear and branching vessels and white scar- like
depigmented areas are present over reddish-brown background
• Dermoscopy of lupus miliaris
disseminatus faciei shows multiple,
ill-defined, discrete, yellow to
orange brown, structureless areas
(blue arrows), arranged focally in
perifollicular distribution.

• White or yellow keratotic follicular

plugs (red arrows), perifollicular
scales, well-focused linear and
arborizing vessels (yellow arrows)
present on over reddish-brown
background (white arrows)
• Dermoscopy of lupus miliaris
disseminatus faciei shows multiple, ill-
defined, discrete, yellow to orangish
brown, structureless areas (blue
arrows), arranged focally around
follicles.

• White or yellow keratotic follicular

plugs (red arrows) perifollicular scales,
• well-focused linear and arborizing
vessels (yellow arrows) seen
• over a reddish-brown background
(white arrow)
• Dermoscopy of lupus miliaris
disseminatus faciei shows white scar-
like depigmented areas (orange
arrows),
• structureless areas (blue arrow),
• short linear vessels (yellow arrows),
and
• reddish-brown background (white
arrows).

• Perifollicular pigmentation is also

noted (green arrow)
Key Points
• Multiple, ill-defined, discrete, perifollicular, yellow to brown,
structureless areas, which represent granulomas.
• Whitish or yellow keratotic follicular plugs and perifollicular scales
• Well-focused linear and arborizing vessels are present.
GRANULOMA FACIALE
Clinical Features
• Clinically, it is characterized by occurrence of asymptomatic, single or
multiple, reddish-brown, papules, plaques or nodules, primarily on
the sun-exposed areas, especially face
• Lesions are usually soft, with prominent follicular openings, giving it a
characteristic orange peel-like surface.
(A) Clinical image of granuloma faciale shows erythematous to violaceous plaque with
prominent follicular openings on nose;
(B) Clinical image of granuloma faciale shows erythematous to brownish plaque with
scaling on the forehead;
 Dermoscopic Features
• It shows pink to reddish-brown background, with some areas of translucent
white-gray color.
• Vascular inflammation, erythrocyte extravasation, and hemosiderin de- position
may contribute to color of lesion.
• Whitish streaks in different directions, associated with fairly focused, linear
branching vessels are commonly seen.
• Prominent follicular orifices or follicular accentuation giving it a “peau d’orange”
appearance clinically, corresponding to the intense inflammatory infiltrate of
lymphohistiocytes, neutrophils, and numerous eosinophils, in a micronodular
arrangement with sparing of adnexal structures of skin.
• An amorphous yellowish or yellow-brown or brown area may be present in the
center of lesion which has been correlated to the presence of abundance of
hemosiderin deposition in these lesions on histopathology
• Dermoscopy of granuloma
faciale shows pink to
reddish-brown background
(red arrow),
• prominent follicular orifices
(green arrows),
• areas of translucent white-
gray color (blue arrows),
• few whitish streaks in
different directions (yellow
arrow), and
• fairly focused, linear
branching vessels (white
arrows)
• Dermoscopy of granuloma
faciale shows reddish-
brown background (red
arrow),
• marked follicular
accentuation (green
arrows),
• areas of translucent white-
gray color (blue arrows),
and
• linear branching vessels
(white arrows)
Key Points
• Pink to reddish-brown background, with some areas of translucent
white-gray color.
• Whitish streaks in different directions, associated with fairly focused,
linear branching vessels
• Prominent follicular orifices or follicular accentuation giving it a “peau
d’orange” appearance
• An amorphous yellowish or yellow-brown or brown area may be
present in the center of lesion.
ERYTHROMELANOSIS FOLLICULARIS
FACIEI ET COLLI
Clinical Features
• A rare disorder described for the first time by Kitamura et al., has
onset during early childhood and occurs predominantly in males.
• Clinically, it is characterized by presence of sharply demarcated
erythema (with or without telangiectasia), reddish-brown patches of
hyperpigmentation along with follicular papules present on face,
mainly cheeks, preauricular and temporal areas, extending over to
involve the submandibular areas of neck
(A) Clinical image of
erythromelanosis follicularis
faciei et colli shows classical
triad of
• erythema,
• hyperpigmentation, and
• follicular papules
• involving preauricular areas,
cheeks, temporal areas, and side
of nose
(B) Clinical image of erythromelanosis follicularis faciei et colli shows erythema, follicular papules, and
hyperpigmentation in a classical distribution over preauricular areas, cheeks, and chin extending on to
temples;
(C) Erythromelanosis follicularis faciei et colli shows erythema, follicular papules, and
hyperpigmentation in a classical distribution over preauricular area and cheek;
Dermoscopic Features
• It reveals whitish scales, numerous follicular keratotic plugs against a
reddish-brown background and telangiectasias, which on
histopathology correspond to presence of hyperkeratotic hair follicles,
orthokeratosis, dilated infundibula with follicular plugging, and
vasodilation and pigmentation of basal layer, respectively.
• Gray-blue dots and granules present in the perifollicular and
interfollicular areas are seen, especially in subjects with longer
durationof disease, and correlate with the presence of pigmentary
incontinence and dermal melanophages, respectively
Dermoscopic Features
• A coiled up or twisted hair retained inside a follicular prominence is
usually observed, with an inflamed follicular papule overlying it.
• White shiny structures (rosettes) were observed in some patients
under polarized light
• (D) Dermoscopy of
erythromelanosis follicularis
faciei et colli shows white
scales, mainly perifollicular in
distribution (green arrows),
numerous follicular keratotic
plugs (blue arrows) against a
reddish-brown background
and telangiectasias (black
arrows).
• Perifollicular and
interfollicular gray-brown dots
and granules (peppering) (red
arrows). Twisted/coiled hairs
(yellow arrow) are also seen
• Dermoscopy of erythromelanosis
follicularis faciei et colli shows white
scales (green arrows), numerous
follicular keratotic plugs (blue arrows)
against a red-brown background and
telangiectasias (black arrows).
• Gray-blue dots and granules present in
the perifollicular and interfollicular areas
(red arrows).
• A coiled up or twisted hair retained
inside a follicular prominence is
observed, withan inflamed follicular
papule overlying it (yellow arrows)
• Dermoscopy of erythromelanosis
follicularis faciei et colli shows
white scales (green arrow),
numerous follicular keratotic plugs
(blue arrows) against a reddish-
brown background and
telangiectasias (black arrow).
• Gray-blue dots and granules
present in the perifollicular and
interfollicular areas (red arrows).
• A coiled up or twisted hair (yellow
arrows) and rosettes (white arrow)
are noted
TOPICAL STEROID-DEPENDENT FACE
• It is common facial dermatosis due to the uncontrolled use of topical
steroids in India.
Dermoscopic Features
• Irregularly dilated, branching tortuous vessels almost interconnecting
with each other are seen on dermoscopy, but between the larger
interconnecting vessels, the smaller nonlinear vessels can be
observed.
• In addition, red dots, white structureless areas and yellow areas,
corresponding to epidermal and dermal atrophy, respectively, and
coarse terminal areas are seen.
• Features like follicular plugs, follicular pustules, and rosettes are not
seen
• (A) Dermoscopy of topical steroid-dependent face shows irregularly dilated, branching tortuous vessels
almost interconnecting with each other (blue arrows), along with white structureless areas (green
arrows) and red dots (yellow arrows)
• (B) Dermoscopy of topical steroid-dependent face shows irregularly dilated, branching tortuous vessels
(blue arrows), white structureless areas (green arrows), and red dots (yellow arrows)
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