funDERMentals
A 12-year-old girl is referred by her pediatrician for evaluation and treatment of facial lesions. She’s had them for almost five years, and several treatment attempts have been unsuccessful. Most recently, she tried topical adapalene gel for presumed acne, but this only irritated the area and had no beneficial effect on the “bumps.” Oral antibiotics did not help, either.
The presenting complaint is complicated somewhat by the fact that the same area of her skin is often dark—a problem thought to be related. The patient admits to licking her lips frequently (something her parents have also observed).
The patient’s history is significant for Hodgkin’s lymphoma, diagnosed and successfully treated five years ago. It was around that time that the bumps first appeared, while she was undergoing chemotherapy.
EXAMINATION
There is a ring of sharply demarcated, modest hyperpigmentation around the entire perioral area, extending outward about 2 cm. Closer questioning reveals that this aspect of the problem “comes and goes.”
The main concern is the collection of planar, pinkish brown papules around the mouth. These are mostly located inferior to the lips, although a few tiny papules are on the maxilla. All papules are uniform in size (≤ 1 mm) and shape. None are inflamed or umbilicated.
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