Can Baykal - Dermatological Diseases of the Nose and Ears: An Illustrated Guide

Can Baykal 1

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Abstract

Macules are flat lesions that show discolouration. The prominent facial position of the nose allows the nasal macular lesions easily be noticed. Hyperpigmented macules on the nose may have different causes. Fixed drug eruption is mostly seen around the mouth and eyelids, however it can also occur as sharply-defined, grey-brown coloured, round or oval macules on the nose. There is often a previous history of inflammatory nummular erythema at the same site. While cotrimoxazole and naproxen are the most common causative agents in fixed drug eruption, a large spectrum of medications can induce these lesions. Drug-induced hyperpigmentation, caused by drugs like amiadarone, quinidine and antimalarials, can affect the nose together with the cheeks and forehead. Such pigmentation is often bluish grey in colour (Fig. 1.1). Clofazimine, which is used for the treatment of leprosy, can induce a diffuse pigmentation that may be prominent on the nose. Hyperpigmentation on the nose together with other sun-exposed sites of the face can occur after PUVA therapy (Fig. 1.2). Facial hyperpigmentation of melasma, which is typically located on the forehead, cheeks, chin and around the lips, can also involve the nose. This common cosmetic problem is primarily seen in women and may occur during pregnancy. Typical light-brown patches have irregular borders.

Macules are flat lesions that show discolouration. The prominent facial position of the nose allows the nasal macular lesions easily be noticed. Hyperpigmented macules on the nose may have different causes. Fixed drug eruption is mostly seen around the mouth and eyelids, however it can also occur as sharply-defined, grey-brown coloured, round or oval macules on the nose. There is often a previous history of inflammatory nummular erythema at the same site. While cotrimoxazole and naproxen are the most common causative agents in fixed drug eruption, a large spectrum of medications can induce these lesions. Drug-induced hyperpigmentation, caused by drugs like amiadarone, quinidine and antimalarials, can affect the nose together with the cheeks and forehead. Such pigmentation is often bluish grey in colour (Fig. ). Facial hyperpigmentation of melasma, which is typically located on the forehead, cheeks, chin and around the lips, can also involve the nose. This common cosmetic problem is primarily seen in women and may occur during pregnancy. Typical light-brown patches have irregular borders.

Skin lesions of ochronosis (alkaptonuria) which result from the deposition of homogentisic acid are most likely to occur prominently in middle age. The persistent irregular pigmentation is greyish or bluish black in colour, located mostly on the skin overlying the cartilage tissue such as the nose and ears (Fig. ). Acanthosis nigricans, which is often seen in flexural areas, can also present with hyperpigmentation on ala nasi. Severe forms and atypically located lesions can be associated with malignancies.

Ephelides (freckles) are common pigmented lesions of the nose and cheeks which are often seen in early childhood (Fig. ). Eyelids, forehead, temple, nasal root and ala nasi can be affected by this dermal melanocytic tumor. Bluish grey pigmentation of the sclera may be prominent in some patients. Pigmentation can also be seen in the nasal mucosa. Rarely, malignant melanoma can develop on the macular skin lesions. Therefore the patients must be followed up regularly.

The hypopigmented macules on the nose are usually caused by vitiligo (Fig. ) or hyperpigmentation after they resolve.

Erythema, purpura and angiomatous lesions can present with red macules. Erythema can disappear spontaneously after a short period of time or persist in some diseases. The malar rash in systemic lupus erythematosus (SLE) is noticed on both cheeks and nasal bridge as persistent, asymptomatic erythema (Fig. ). This chronic disease is more commonly seen in middle-aged women. While erythema on the nose can be the only manifestation, pink hemispherical papules, pustules and telangiectases can also be observed. Sometimes erythema shows a butterfly pattern similar to SLE. But, systemic symptoms do not accompany rosacea. Perioral dermatitis, which usually occurs after the prolonged use of topical corticosteroids, can also cause erythema or small papulopustular lesions on the nose in addition to the typical perioral lesions.