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.

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us:

Just published

GMC sanction 12 times more likely for doctors who do badly in postgrad exams

GMC sanction 12 times more likely for doctors who do badly in postgrad exams

Doctors who perform poorly in postgraduate professional exams are twelve times more...

GP indemnity costs set to rise under government regulation plans

GP indemnity costs set to rise under government regulation plans

GPs could face increased costs under plans to regulate provision of medical indemnity,...

New vitamin D guidelines aim to provide clarity on testing and prescribing

New vitamin D guidelines aim to provide clarity on testing and prescribing

Dr Terry Aspray explains what the National Osteoporosis Society's new clinical guidelines...

GPs deliver more than 1m appointments a day, official data show

GPs deliver more than 1m appointments a day, official data show

GPs across England delivered a total of 307.4m appointments in the year to 31 October...

GP practices face data protection fines worth hundreds of pounds

GP practices face data protection fines worth hundreds of pounds

GP practices are among hundreds of organisations threatened with cash fines for failing...

Heavy workload 'driving up GP referrals and preventing accurate diagnosis'

Heavy workload 'driving up GP referrals and preventing accurate diagnosis'

Heavy workload is forcing GPs to refer more patients to hospital while undermining...