Photo Rounds

Black spots on both sides of face

A 66-year-old man with borderline diabetes went to see his family physician (FP) because he was concerned about the black spots lateral to his eyes on both sides of his face. He said that the spots had developed over the past 2 years and appeared to be increasing in number and size. He had worked most of his adult life outdoors as a gardener.

What's your diagnosis?


The FP diagnosed actinic (solar) comedones in this patient. When actinic comedones are found in association with solar elastosis of the skin (yellowish thickening and furrows), this is known as Favre-Racouchot syndrome. In this case, the patient had actinic comedones with mild to no solar elastosis. This condition tends to affect older individuals who have had significant sun exposure.

Treatment options include acne surgery to remove each comedone one at a time and/or the use of a topical retinoid to treat and prevent further open comedones.

In this case, the patient opted for acne surgery on the largest of the open comedones. The FP used a number 11 blade (without anesthesia) to lightly nick open the comedone and extracted the keratin plug with a comedone extractor. She then prescribed topical 0.025% tretinoin cream to be used at night before bed. The patient was also advised to use a hat with a large brim and sunscreen to avoid additional sun damage.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Usatine R. Acne vulgaris. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:651-658.

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