Many diagnoses are possible by just looking at the patient's face. Some examples are given
1. Myxedematous or Torpid Facies—Patient have expressionless face & apathetic look.Face is puffy with periorbital swelling, boggy eyelids and loss of outer 1/3 rd of the eyebrows. Xanthelasmas may be present. Skin is cool & dry. There may be malar flush.
2. Thyrotoxic face or Graves’ disease— Patient appears anxious, restless and fidgety. Unilateral or bilateral proptosis. Thyroid gland may be diffusely enlarged.
3. Cretinism—Congenital Hypothyroidism. Mental retardation results in idiotic look on face. Coarse skin with thick lips, large ears.
4. Cushingoid face— Rounded, plethoric face giving rise to moon face appearance. There may be hirsutism and acne.
5. Acromegalic face— Coarse facial features with prominent supraorbital ridges. Increased wrinkling of the forehead. Jaw is protruded forward (Prognathism). Nose, lips and ears are large.
6. Dermatomyositis - Heliotrope rash which is a purplish color or lilac rash, but may also be red. It can occur around the eyes along with swelling but also occurs on the upper chest or back what is called the "shawl" (around the neck) or "V-sign" above the breasts and may also occur on the face, upper arms, thighs, or hands.
7. Systemic Lupus Erythematosus - Photosensitive rash over both cheeks and bridge of the nose, popularly known as ‘Butterfly Rash’.
8. Systemic Sclerosis - kin is smooth, shiny & tight with hypopigmented and hyperpigmented areas. Nose is pinched up and tapered (beaking of nose, bird beak). Loss of wrinkling of forehead. Lips are thin, pursed with puckered skin around mouth. Mouth orifice is small (microstomia).
9. Thalassemic Facies - Expanded globular maxillae, due to bone marrow hyperexpansion into facial bones, combined with prominent epicanthal folds & frontal bossing. This facies is also called ‘Chipmunk Facies’.
10. Parkinsonian Facies - Mask like, expressionless face with absent/reduced blinking of eyes, staring & vacant look, and dribbling of saliva. Weakness of upward gaze, seborrhoea and sweatiness.
11. Myopathic Facies - Frontal baldness. Bilateral ptosis. Long, lean, triangular (Hatchet facies), sad and expressionless face with wasting of temporalis and masseter.
12. Myasthenic facies - Snarling facies’ in Myasthenia gravis is due to ptosis (usually bilateral) & drooping of corners of the mouth, and weakness of the facial muscles. There is usually frontalis overactivity to compensate for ptosis.
13. Down’s syndrome— Flat appearing face, small head, flat bridge of the nose, smaller than normal, low-set nose, small mouth which causes the tongue to stick out and to appear overly large, upward slanting eyes, epicanthal fold, rounded cheeks, small misshapen ears.
14. Turner Syndrome - Short and webbed neck, low hairline and redundant skinfold on the back of neck. Small lower jaw (micrognathia), small and fish-like mouth with low set, deformed ears.
15. Marfanoid face - Face is long, lean, elongated and narrow with small jaw leading to crowding of teeth, and high arched palate.
16. Mitral facies - Malar flush is Rosy, flushed cheeks and dilated capillaries.
17. Nephrotic face - Puffy face with periorbital swelling.
18. Sarcoidosis - Lupus pernio is found in sarcoidosis. It is a chronic raised indurated (hardened) lesion of the skin, often purplish in color. It is seen on the nose, ears, cheeks, lips, and forehead.
19. Bell's palsy - Rolling up of eye on affected side when try to close eye is the Bell’s sign. Moreover, there is loss of wrinkling on forehead, nasolabial fold on effected side.
20. Leonine face - Seen in Lepromatous leprae. Skin of the face and forehead is thick and corrugated. Multiple nodules of variable sizes and shapes involving ear lobule, face and nose.
21. Achondroplasia—Short stature. Skull appears enlarged.
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TITLE: Colourful spots
ARTIST: Nicolai Heidlas