Differential diagnoses: Facial lesions

Dr Nigel Stollery compares four facial lesions and offers clues for their diagnosis including syringoma, milia, xanthelasma, sebaceous gland hyperplasia

Syringoma

Presentation

  • Small, round, translucent papules
  • 1-5mm diameter
  • Very common benign sweat gland tumours
  • Occur on face around eyelids
  • Autosomal dominant trait
  • Usually first appear after puberty

Management

  • No treatment required
  • If necessary, cautery or hyfrecation can be used

Milia

Presentation

  • Small, superficial epidermoid cysts
  • 1-2mm diameter
  • White, spherical papules protruding above the surface
  • Occur on cheeks and around eyelids
  • May arise spontaneously or after acute subepidermal blister, such as a burn

Management

  • Treatment not usually required
  • Cautery or hyfrecation can be used if necessary

Xanthelasma

Presentation

  • Flat, yellow plaques of varying size
  • Benign with no malignant potential
  • Most common on medial aspect of eyelids
  • Often associated with hyperlipidaemia, but can occur with normal lipid levels
  • If lipids are high, xanthelasma decreases in size once the lipids have been lowered

Management

  • Treatment options include trichloroacetic acid applied directly to plaques, and hyfrecation

Sebaceous gland hyperplasia

Presentation

  • Common condition caused by hypertrophy of normal sebaceous glands
  • Skin-coloured or yellow papules
  • Occur on face in areas that are sebum-rich
  • 2-5mm diameter
  • Often multiple lesions present
  • Central punctum usually visible
  • Surface telangiectasia often present
  • Main differential is basal cell carcinoma, especially if single lesion

Management

  • Cautery under local anaesthesia
  • If diagnostic doubt, tissue should be sent for histology
  • Dr Stollery is a GP in Kibworth, Leicestershire, and clinical assistant in dermatology at Leicester Royal Infirmary.

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