September 2021 - Case of the Month
A 24-year-old woman presented with a several year history of evolving 'lumps' especially on the central chest. The lady had mild facial acne and was otherwise well.
A Happy New Year to all.
To kick off the New Year we have an interesting case. A 43 year old lady presented with a two year history of an asymptomatic, persistent facial rash that had changed little. There were no exacerbating and relieving factors and none of the topical treatments prescribed by the GP had helped. There was no other relevant personal or family history of skin problems and the patient was taking no medications. The patient had an office-based job and there were no relevant hobbies.
There was symmetrical erythema of the central face from the medial eyebrows down the sides of the nose and on to the chin, there was additional erythema on the upper cheeks with sparing under the eyes. There was no scale, papules or pustules. There were also numerous very fixed red to orange macules/patches on the face especially affecting both cheeks. There was no involvement of other sites including the ears, scalp, flexures, natal cleft and nails.
The lady was presented at our monthly dermatology clinical meeting where the diagnosis was felt to be a combination of seborrhoeic eczema, possibly with a degree of vascular rosacea (especially on the upper cheeks). The features were not in keeping with contact allergic dermatitis, and a previous biopsy (and immunofluorescence) had not shown features of lupus.
What was unusual in this case was that the lesions on the cheek were very fixed and there had been no response (even temporary) to emollients, a range of topical steroids, immunomodulators (pimecolimus cream and tacrolimus ointment), 2 weeks of itraconazole and moderate term tetracycline's (used for their anti-inflammatory effects).
Shortly after the meeting a case was discussed in CED (Clinical and Experimental Dermatology) of a patient with identical symptoms. The diagnosis was said to be that of Facial Focal Dermatosis (FFD) of which there have been only a few case reports. The cause of FFD is unknown and as with our patient there has not been found a reliably effective treatment, including phototherapy, having said that my patient is currently having a trial of TL01 phototherapy, and I will report back if this is helpful.
Images copied with kind permission from South Tees Foundation Trust.
A 24-year-old woman presented with a several year history of evolving 'lumps' especially on the central chest. The lady had mild facial acne and was otherwise well.
A 52 year old man presented with a one year history of skin lesions predominantly on his hands, ears and scalp. He was also complaining of painful swollen fingers associated with morning stiffness. There was no family history of skin or joint problem...
A 72 year old man was referred with a rash, predominantly on the legs. The patient was systemically well and the lesions were only mildly symptomatic. The lesions presented as one to several at a time lasting several weeks. They had not res...
Welcome back to the new look PCDS website, and our first case. This lady was referred as a 2-week wait with a changing lesion on the right temple.
A 15 year old lady was referred for a diagnostic opinion for skin changes presenting in birth, affecting the right upper back, shoulder, antecubital fossa and dorsal wrist. The patient was asymptomatic and otherwise well.
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