Do You Recognize These Cystic Lesions?

Adam R. Taintor, MD


July 29, 2010

History and Clinical Presentation


A 15-year-old black patient presents for a follow-up appointment for acne in the dermatology clinic. He had previously been seen 2 years earlier. Since his last visit, he had been using a tretinoin 0.01% gel at night and benzoyl peroxide 5% wash every morning, but he ran out of benzoyl peroxide 6-7 months ago and is currently washing his face with water only. The patient complains that over the past 1-2 years his skin lesions have become more diffuse with involvement of his arms, legs, chest, abdomen, groin, and upper legs. The patient cites a family history of similar acne lesions on the body of his father.

Physical Examination

This patient is a well-appearing, well-nourished adolescent. His skin was notable for diffuse, scattered, open and closed comedones on the forehead, cheeks, nose, and chin (Figure 1). In addition, there are many scattered and widespread monomorphous, slightly yellow 3- to 8-mm cysts over the chest, abdomen, flexor surface of the arms, upper legs, and groin (Figures 2, 3).

Figure 1. Open and closed comedones on the forehead, cheeks, nose, and chin.

Figure 2. Scattered monomorphous cysts.

Figure 3. Scattered monomorphous cysts.