Acneiform Lesion: Importance of Detailed Skin Examination

Excerpt

A 10-y-old boy, with acneiform lesion over the face, came to the general pediatrics clinic for a second opinion. He had an unremarkable past and family history except his mild social anxiety. The skin lesion started few years back as redness over central face area which gradually progressed over the last 2 y. It remained resistant to topical retinoid, benzoyl peroxide, and oral antibiotics. Physical examination revealed healthy looking boy with multiple, subcentemetric, dome- shaped, red and skin color papules with a smooth surface. They were most prominent over the central face involving the nasolabial folds and extending on to the cheeks. Lateral face and upper lips were relatively spared. Review of history and systemic examination were normal except 4 hypopigmented macules, measuring 0.5–1 cms, were noted over trunk and legs during meticulous skin examination. Diagnosis of Tuberous sclerosis complex (TSC) was made clinically in presence of two major features- facial angiofibroma and ‘ash leaf spots’[1]. Additional work up was completed; brain MRI revealed cortical tubers and subependymal nodules. Genetic test confirmed TSC1 genetic mutation. …