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JAMA Dermatology Clinicopathological Challenge
December 26, 2019

Facial Asymmetry With Deviated Nasal Tip

Author Affiliations
  • 1Division of Dermatology, University of Louisville School of Medicine, Louisville, Kentucky
JAMA Dermatol. Published online December 26, 2019. doi:10.1001/jamadermatol.2019.3890

A woman in her 40s presented to the dermatology clinic with a 10-year history of progressive skin thickening and subcutaneous enlargement of the right side of her nose and right cheek. She had been seen by several dermatologists and otolaryngologists and had undergone nondiagnostic skin biopsies. She underwent a septorhinoplasty 6 months prior to presentation because of collapse of her right nasal ala. During the surgical procedure, the surgeon noted a significant amount of submucosal tissue in the right nasal cavity, which was removed; histopathological analysis was performed, and the results were reported as fibroadipose tissue and vascular proliferation. A skin biopsy was performed at the time of the surgical procedure and was interpreted as sebaceous hyperplasia. The patient initially had improvement in her skin, but she again noticed enlargement of the soft tissue with thickening of the overlying skin on her right cheek and right side of her nose several months later.

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