Closed comedones
Presentation
- Usually single lesions, but multiple may occur.
- More commonly seen in patients with acne.
- Affect middle-aged and elderly more than younger people.
- Found mostly in sebum-rich areas, such as the back, chest and face.
Management
- Diagnosis usually made on clinical appearance.
- Most lesions can be treated by applying pressure and squeezing out the contents.
- Recurrences are common.
- Persistent lesions can be treated with cautery.
- Retinoids may be helpful, but there have been no formal trials.
Keratosis pilaris
Presentation
- Very common (40-50% of adults) autosomal dominant condition.
- Occurs on upper outer arms, back, thighs and cheeks.
- Often mistaken for acne vulgaris.
- More common in females than males.
- Usually asymptomatic, but cosmetically problematic.
Management
- Treatment consists of emollients and keratolytics, such as urea, lactic acid and salicylic acid.
- Retinoids often helpful.
- No treatment is particularly effective.
Milia
Presentation
- Usually multiple lesions on face.
- Very common, benign, keratin-filled cysts (50% of infants affected).
- Affects all ages from infancy to the elderly.
- Less than 2mm in diameter.
- Usually asymptomatic, but may be itchy.
Management
- Often no treatment is required.
- In infants, usually resolves after a few weeks, but may last a lot longer in adults.
- Treatments include simple rupturing with a sterile needle or hyfrecation, usually without the need for anaesthesia.
Molluscum contagiosum
Presentation
- Benign viral skin infection producing multiple papules.
- Common in children, may be sexually transmitted in adults.
- Lesions vary in size (2-5mm) and have an umbilicated centre.
- Usually asymptomatic, but secondary bacterial infection may occur.
Management
- Usually self-limiting in healthy people; no treatment required.
- Treatment includes direct lesional trauma by rupturing or squeezing.
- In more persistent or severe cases, imiquimod may help.
- Any treatments may increase the risk of scarring.
- Dr Stollery is a GP in Kibworth, Leicestershire
