Dermatology: Practical and Conceptual


308 Letter  |  Dermatol Pract Concept 2019;9(4):15

Dermatology Practical & Conceptual

Introduction

We read with great interest a case report by Chessa et al [1], 

which seems to be the first case describing the distinct clinical 

and dermoscopic features of Favre-Racouchot disease (FRD). 

We present another patient with similar features.

Case Presentation

A 71-year-old man, retired bricklayer, presented with an 

asymptomatic, erythematous plaque with agminated whitish 

waxy and hyperkeratotic papules within the right malar area 

(Figure 1A). The lesion had developed several months before. 

A Case of Unilateral Inflamed Plaques With Comedones 
on the Face: Another Case of an Uncommon Clinical 

Presentation of Favre-Racouchot Disease
Michał Sobjanek1, Martyna Sławińska1, Wojciech Biernat2

1 Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Poland
2 Department of Pathomorphology, Medical University of Gdańsk, Poland

Key words: Favre-Racouchot disease, comedones, nodules and cysts, solar elastosis, yellowish lobular-like pattern

Citation: Sobjanek M, Sławińska M, Biernat W. A case of unilateral inflamed plaques with comedones on the face: another case of an 
uncommon clinical presentation of Favre-Racouchot disease. Dermatol Pract Concept. 2019;9(4):308-309. DOI: https://doi.org/10.5826/
dpc.0904a15

Accepted: April 10, 2019; Published: October 31, 2019

Copyright: ©2019 Sobjanek et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, 
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: None.

Competing interests: The authors have no conflicts of interest to disclose.

Authorship: All authors have contributed significantly to this publication.

Corresponding author: Martyna Sławińska, MD, Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, 
Smoluchowskiego 17 St, 80-214 Gdańsk, Poland. Email: mslawinska@gumed.edu.pl

Figure 1. (A) Clinical presentation: 

an erythematous plaque with agmi-

nated whitish waxy and hyperkera-

totic papules within the right malar 

area. (B,C) Dermoscopic presenta-

tion: pinkish white globular struc-

tures intersected with the yellowish 

structureless areas corresponding 

with the presence of a crust. [Copy-

right: ©2019 Sobjanek et al.]

A B

C



Letter  |  Dermatol Pract Concept 2019;9(4):15 309

and to our knowledge not typical of any 

known dermatosis.

References
1. Chessa MA, Filippi F, Ferrara F, Patrizi A, 

Baraldi C. A case of unilateral inflamed 

plaques with comedones of the face. Der-

matol Pract Concept. 2018;8(4):292-294.

2. Paganelli A, Mandel VD, Kaleci S, Pella-

cani G, Rossi E. Favre-Racouchot disease: 

systematic review and possible therapeutic 

strategies. J Eur Acad Dermatol Venereol. 

2019;33(1):32-41.

Conclusions
FRD is a relatively common disorder, 

and usually the diagnosis can be simply 

made based on clinical presentation [2]. 

The unique morphology and unilateral 

location in both discussed cases made 

the diagnosis more difficult. The pres-

ence of disseminated comedones and 

signs of photo-damage could serve as 

a clue to diagnosis. Dermoscopic pre-

sentation in both cases was very similar 

In addition, disseminated individual 

comedones, small cysts, solar elasto-

sis, and telangiectasia were present on 

both cheeks and nose. The patient had 

a history of basal cell carcinoma, hidra-

denitis suppurativa, type 2 diabetes, 

permanent atrial fibrillation, 25 pack-

years of cigarette smoking, and chronic 

professional as well as recreational sun 

exposure. Dermoscopy showed pinkish 

white globular structures intersected 

with the yellowish structureless areas 

corresponding with the presence of a 

crust (Figure 1, B and C).

In differential diagnosis FRD, pyo-

derma vegetans, sarcoidosis, tubercu-

losis, and papillated variant of Bowen 

disease were considered. Histopatho-

logical examination revealed cryp-

tic invagination of the infundibular 

portion of the hair follicle filled with 

the horny material with overhanging 

polypoid protrusion of the skin with 

comedo-like dilation of the other infun-

dibulum, confirming the diagnosis of 

FRD (Figure 2).

Figure 2. (A) Cryptic invagination of the infundibular portion of the hair follicle filled with 

the horny material with overhanging polypoid protrusion of the skin with comedo-like di-

lation of the other infundibulum. (B) One of the follicles shows suppurative inflammation 

and dense lymphoplasmacellular infiltrate in the stroma. [Copyright: ©2019 Sobjanek et al.]

A B