Multiple cysts and comedones about the eyes.

FAVRE-RACOUCHOT SYNDROME

Favre-Racouchot syndrome (FRS) is the presence of comedones (blackheads and whiteheads) in the sun-exposed areas (usually the temples/cheeks) of an elderly person.

• One report showed that this condition is much more common in those who smoke.
  
• Another histologic study showed that the cysts and comedones of FRS are histologically identical to the closed and open comedones of acne vulgaris with the exception of marked actinic elastosis in the surrounding dermis.
• The lesions are not epidermal inclusion cysts, but instead primary comedones as evidenced by the type of horny material, the presence of hair shafts, the abundant sebum, and bacteria present.
• Radiation therapy may at times induce FRS.
  

Clinical

Cysts and comedones about the lateral eyes and cheeks in a middle-aged to elderly patient with a significant history of sun exposure is characteristic. The comedones may occur in groups. A rare case of large bilateral nodules has been reported.

Treatment

Any patients who smoke should stop. Sun protection to prevent further disease is to be recommended. No treatment is needed. Adapalene or tretinoin QHS may be tried.

I personally have found lidocaine followed by curettage of the cysts and comedones followed by healing through secondary intention to be effective with reasonable cosmetic results.

Laser

A two-step treatment of CO2 laser resurfacing and manual pressure-induced expression of comedones was reported as an effective and durable treatment for FRS with an excellent cosmetic outcome.

RegionalDerm

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