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

A 'tsunami' of work is drowning general practice: GPs speak out about a profession at its limit

A 'tsunami' of work is drowning general practice: GPs speak out about a profession at its limit

Rocketing workloads created by huge backlogs of cases and continuing COVID-19 disruption...

Slight increase in GP workforce during past year, but number of partners continues to fall

Slight increase in GP workforce during past year, but number of partners continues to fall

The GP workforce grew by 0.4% in the year to March 2021, but the number of GP partners...

Viewpoint: Patients and GPs are unhappy with access to general practice, what's the solution?

Viewpoint: Patients and GPs are unhappy with access to general practice, what's the solution?

Practices are deluged with work, yet many people still think they are ‘closed’. The...

Start date for COVID-19 booster campaign unclear, vaccines minister admits

Start date for COVID-19 booster campaign unclear, vaccines minister admits

A UK COVID-19 booster campaign could start from September - but could also remain...

BMA demands 'systemic change' after LMC report exposes racism in primary care

BMA demands 'systemic change' after LMC report exposes racism in primary care

Most black, Asian and minority ethnic primary care staff have experienced racism...

UK COVID-19 vaccination programme tracker

UK COVID-19 vaccination programme tracker

GPs across the UK are playing a leading role in the largest-ever NHS vaccination...