Wednesday, November 16, 2005

A Patient from Ghana - Please comment

Anak VGRD members have been asked to comment on a 16 year old Ghanaian girl from a small village without any specialized medical care. In otherwise good health and of normal intelligence, since age two she has a history of small hyperpigmented papules on her face. The larger lesions on her forehead appeared over the last two years. She patient states that she doesn't manipulate any of the lesions and that they are asymptomatic. There has been no treatment. HIV status and family history are unknown. This unfortunate young woman feels like an outcast because of these lesions.

We welcome you thoughts and advice. There are medical students in her community who could perhaps perform diagnostic testing if needed.


  1. This young lady should have these lesions biopsied. Might she have XP or a variant?

  2. This is a interesting clinical problem. It would be difficult to decide what to do with this patient under such circumstances as resources would be scarce. Ideally. a skin biopsy should be done to confirm whatever clinical suspicion we have.

    But based on the clinical features, the distribution of the papules are limited to the face so this would make XP unlikely. I would expect XP to be more extensive and more generalised. Tuberous sclerosis is a possibility but there are scarring over the forehead.

    I would therefore consider other differential diagnoses: cutanoeus sarcoidosis, papular rosacea and acne agminata. A biopsy would therefore be most helpful.


  3. Could those medical students look for other signs of TS? ash leaf macules? Koenen's tumors?


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