Presenter: Chris Hixon, DO
Dermatology Program: Lewis Gale Hospital Montgomery
Program Director: Daniel Hurd, DO, FAOCD
Submitted on: December 3, 2013
CHIEF COMPLAINT: Facial “acne” that has been present her entire life
CLINICAL HISTORY: A 23-year-old female presented to our dermatology clinic seeking treatment for worsening facial “acne,” a condition she has experienced for her entire life. During her initial visit, she was found to have diffuse closed comedones and flesh-colored papules on her forehead and lateral cheeks, along with areas of “ice pick” and atrophic scarring, as well as focal post-inflammatory hyperpigmentation (PIH). Her previous treatments included over-the-counter Clean & Clear Blackhead Eraser, Tazorac 0.05% cream applied nightly, Minocycline 100 mg daily, Doxycycline 150 mg daily, and Tretinoin 0.025% cream applied nightly. Notably, her dermatological history revealed a family history of acne, with both her and her father affected. She reported no chronic medical conditions, but her family history included instances of seizures.
PHYSICAL EXAM:
Skin exam revealed >50 closed comedones and > 50 flesh-colored papules with the greatest concentration of both being on the forehead and cheeks. There was also focal involvement of the temples, chin, and jawline. Randomly scattered foci of acne scarring and PIH were also noted.
LABORATORY TESTS: N/A
DERMATOHISTOPATHOLOGY:
The cyst itself contains variable amounts of keratin as well as multiple transverse and obliquely cut vellus hairs.
DIFFERENTIAL DIAGNOSIS:
1. Acne Vulgaris
2. Steatocystoma Multiplex
3. Milia
4. Eruptive Vellus Hair Cysts
5. Multiple Syringomas
