A 72-Year-Old Man with Black Skin Lesions

Differential Diagnosis

• Acne vulgaris
• Colloid milium
• Favre and Racouchot disease
• Sebaceous hyperplasia
• Syringomas

Diagnosis

This patient was diagnosed with Favre-Racouchot disease (FRD), also known as solar or senile comedones.

Learnings

• FRD is a disorder of the skin, resulting from chronic exposure to the sun and culminating with small cysts and large blackheads that form on the face and neck. It is also more common in patients with a heavy smoking history, in males, and in whites.
• Unlike the comedones in acne vulgaris, FRD comedones do not become inflamed
• The lesions are most commonly seen on the face (in particular on the temples, cheeks, and periorbital area) of elderly adults

Pearls for Urgent Care Management and Considerations for Transfer

• Because FRD is benign, any treatment, other than advising the patient to use sun-protection measures, would be for cosmetic purposes only

Acknowledgment: Images courtesy of VisualDx.