Face Papules

Papules on the face

 

The differential diagnoses of facial papules is one of the classic differentials in dermatology.Usually a distinction is made on the basis of site and this is illustrated below.Benign lesions such as dermal nevi,sebaceous hyperplasia,plane warts,molluscum contagiosum,angiofibroma of the nose and syringomas around the eyes are the commonest lesions.In white people Bccs present looking like dermal nevi until they break down centrally,ulcerate and crust.Seborrhoeic keratoses are not always brown and malignant melanoma is not always black.Xanthelasma is common around the eyelids.

The rarer papules such as trichoepitheliomas and peri follicular fibromas may need a biopsy for diagnosis.

 

 

SIGN DIP MEN   Overview of Papules

 

This is an extremely difficult area to give an all encompassing nemonic but  SIGN DIP LAPPIS can be used where L=Lichen etc,A=Adnexae,P=Pediculosis,P=Perforating diseases,I=Infiltrates xanthoma etc,and S=Syndromes Grover’s,Darier’s, Albopapuloid EB etc

 

It is probably best to view the differential diagnosis of papules in particular situations

Monomorphic micropapules in a group    Lichen nitidus,keratosis spinulosa,follicular eczema,follicular mucinosis,lichen scrofulosorum,sarcoidosis,lichen planus,keratosis pilaris

 

Polymorphic papules with necrosis     Pityriasis lichenoides ,lymphomatoid papulosis,papulonecrotic tuberculid,Wegener’s granuloma,allergic granulomatosis,leukocytoclastic vasculitis,insect bites,acne necrotica,acnitis.

 

Keratotic papules forming rings or arciform lesions   porokeratoses,perforating collagenoses,Kyrles disease,Elastosis perforans serpiginosa

 

Inflammatory papular dermatitis in children    Gianoti Crosti syndrome,Papular acral located syndrome,papular urticaria,frictional dermatitis,Bindii dermatitis,caterpillar hairs,mite bites,benign cephalic histiocytosis

 

Facial adnexal papules  Syringoma,trichoepithelioma,pilomatricoma,adenoma sebaceum,benign cephalic histiocytosis,Cowden’s syndrome

 

Eyelid Papules   Milia,molluscum contagiosum,xanthoma,xanthogranuoma,amyloid,trichoepithelioma,Syringomas,acnitis,Cowden’s,Lipoid proteinosis,papular mucinosis

 

Multiple papules in the mouth    Cowdens,Darier’s,Goltz,florid oral papillomatosis,xanthoma disseminatum,reticulo histiocytosis,lipoid proteinosis,adenoma sebaceum,drugs,pyostomatitis vegetans,verrucous carcinoma

 

Acral papules   warts,Gianotti-Crosti,Cowden’s,Multicentric reticulohistiocytosis,epidermodysplasia verruciformis,viral infection

 

Follicular Papules   Keratosis pilaris,lichen spinulosus,lichen planopilaris,Pityriasis rubra pilaris,lichen sclerosus,follicular mucinosis,discoid lupus erythematosus,vitamin d deficiency,fatty acid deficiency

SIGN DIP NIGL

N Nutritional Vit A,Vit C,essential fatty acid deficiency

I Infiltrates

G Genodermatoses Darier’s,Downs,Kyrles.

L Lichenoid