Clinical Challenge: Comedones on the Cheeks - MPR

Clinical Challenge: Comedones on the Cheeks

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A 79-year-old man presents for treatment of a forehead cyst that has been excised surgically, but an incidental examination finds multiple open comedones affecting both cheeks. The patient states that these have been present for a long time and he is not concerned about them. The patient’s facial skin is sallow, thickened, and leathery. He worked outdoors for decades and has smoked cigarettes since he was a teenager.

Favre-Racouchot syndrome is named after the French dermatologists who first characterized the disorder.1 The condition is often found in elderly individuals, and there is a significant male predominance. Those affected are usually white and have long-term sun exposure. Many are...

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Favre-Racouchot syndrome is named after the French dermatologists who first characterized the disorder.1 The condition is often found in elderly individuals, and there is a significant male predominance. Those affected are usually white and have long-term sun exposure. Many are heavy cigarette smokers.2

Favre-Racouchot syndrome is defined by the presence of multiple open and closed comedones on the cheeks and periorbital areas. The skin manifests chronic sun damage such as yellowish discoloration, wrinkles, and furrows. Accompanying skin lesions include non-inflammatory papules and cysts.

With the exception of the relationship with chronic sunlight exposure and tobacco use, the pathogenesis of this condition is unknown. Effective treatment should be accompanied by smoking cessation and instructions to use sun protection.

Comedone extraction and topical application of tretinoin have been used for decades as first-line therapies.3,4 Good results have also been documented with the use of a carbon dioxide laser.5 

Stephen Schleicher, MD, is an associate professor of medicine at the Commonwealth Medical College in Scranton, Pennsylvania, and an adjunct assistant professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. He practices dermatology in Hazleton, Pennsylvania.

References

  1. 1. Favre M, Racouchot J. [Nodular cutaneous elasteidosis with cysts and comedones]. Ann Dermatol Syphiligr (Paris). 1951;78(6):681-702.
  2. 2. Keough GC, Laws RA, Elston DM. Favre-Racouchot syndrome: a case for smokers’ comedones. Arch Dermatol. 1997;133(6):796-797.
  3. 3. Kligman AM, Plewig G, Mills OH Jr. Topically applied tretinoin for senile (solar) comedones. Arch Dermatol. 1971;104(4):420-421.
  4. 4. Sharkey MJ, Keller RA, Grabski WJ, McCollough ML. Favre-Racouchot syndrome. A combined therapeutic approach. Arch Dermatol. 1992;128(5):615-616.
  5. 5. Rai S, Madan V, August PJ, Ferguson JE. Favre-Racouchot syndrome: a novel two-step treatment approach using the carbon dioxide laser. Br J Dermatol. 2014;170(3):657-660.