What do you see when you look in the mirror?

On the face of it…

Dr. Siobhan Deshauer shows us what to look out for:

• Acne vs mimics: true acne is identified by whiteheads and blackheads, while rosacea shows background redness and visible telangiectasia without comedones and perioral dermatitis clusters around the mouth while sparing the skin just above the lip. Notably, a non-healing pimple can be basal cell carcinoma and should be checked.
  • Acne lesion types: closed comedones are whiteheads, open comedones are blackheads, inflamed lesions are papules or pustules, and severe disease includes deeper nodules and cysts.
  • Hormonal acne: androgens drive oil production and insulin resistance contributes in adults, with polycystic ovary syndrome combining high testosterone, insulin resistance, skin tags, and acanthosis nigricans.
  • Metabolic factors for acne: reducing added sugar, increasing fiber, exercising, and sleeping well can reduce acne while (of course) lowering cardiometabolic risk.
• Cortisol and moon face: chronic high cortisol in Cushing syndrome causes rapid facial rounding, cheek and temporal fat, facial redness, and associated signs like supraclavicular fat, dorsocervical fat, easy bruising, and wide abdominal striae.
  • This isn’t nearly as common as social media makes it out to be, however.
  • A much more common cause is simply enjoying too much salt and thus getting some puffiness for osmotic reasons.
  • Creatine can cause this, too, especially when first taking it. Just drink more water and if it goes away, that’s what it was.
• Polycythemia and redness: excessive hemoglobin from marrow overproduction or chronic low oxygen thickens blood and raises risks of headache, paresthesias, clots, stroke, and myocardial infarction.
• Venous obstruction: impaired head and neck venous drainage causes facial redness, and a positive Pemberton sign—facial reddening with arms raised—needs urgent attention.
• Rosacea features and risks: central facial redness with trigger flares can progress to lymphedema or rhinophyma and is associated with higher rates of cardiovascular disease, autoimmune disease, and Helicobacter pylori infection though causality is unclear.
• Flushing patterns: brief hot redness suggests vasodilation (which can be from many things, ranging from emotion to menopause), while flushing with diarrhea and wheeze raises concern for carcinoid syndrome, which is quite another matter entirely, and one that certainly merits getting checked out.
• Atopy on the face: allergic predisposition often shows dark under-eye circles, Dennie–Morgan lines, a nasal crease, keratosis pilaris, white dermatographism, and facial eczema on cheeks and eyelids.
• Eczema : itching precedes rash, eyebrow thinning from rubbing can occur, and improvement follows treatment.
• Facial droop emergency: sudden facial weakness requires immediate emergency care because stroke treatments are very much time-sensitive.
  • Stroke screening: FAST—facial droop (F), arm weakness (A), and speech difficulty (S)—means time (T) to call emergency services. Yes, it’s a slightly contrived acronym and has probably resulted in many people desperately trying to remember what “T” stands for, but that’s how it is.
  • Upper vs lower face testing: preserved forehead movement with lower facial weakness suggests stroke, while complete ipsilateral weakness suggests Bell’s palsy.
  • Bell’s palsy causes: facial nerve swelling in a narrow canal leads to paralysis, with named causes like Ramsay Hunt syndrome when varicella zoster is identified.
• Voluntary vs involuntary smiles: different brain pathways explain asymmetric emotional smiles and can mean focal brain disease.
• Parkinson disease facial signs: hypomimia, reduced blink rate, and persistent glabellar blink reflex can appear early. They’re not sufficient for a diagnosis, but it’s a pointer that definitely says “maybe some tests are in order”.
• Growth hormone excess: pituitary tumors cause acromegaly with enlarged nose, lips, jaw, hands, and feet, plus sleep apnea, arthritis, headaches, and bitemporal visual loss.
• Red ears (except earlobes): relapsing polychondritis inflames cartilage while sparing earlobes, leading over time to cauliflower ear, saddle-nose deformity, and airway collapse.

For more on all of this plus visual illustrations (and a discussion of assorted unilateral facial motor control skills that aren’t health indicators), enjoy:

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Want to learn more?

You might also like:

What Your Skin Says About Your Health ← for a more body-wide overview

Take care!