Facial lumps and bumps

Dr Nigel Stollery compares presentations of milia, keratosis pilaris, comedones and molluscum contagiosum.

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

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