Diffuse Planar Xanthoma Involving the Face in a Mask-Like Distribution

      A 37-year-old woman reported a yellowish discoloration over her nose, cheeks, and earlobes for the last 5 years, with newer lesions appearing on her forearms over the last year. She was perturbed by its appearance but otherwise asymptomatic and was systemically well. Examination revealed a large symmetrical confluent yellow plaque over the nasal bridge extending to both cheeks, sparing the lower eyelids and nasolabial folds, in a striking mask-like distribution, reminiscent of a thick layer of foundation (Figures 1A and B). Similar yellow plaques were noted over the left upper eyelid, both earlobes, and her anterior forearms. The intertriginous areas and palmar creases were spared.
      Figure 1
      Figure 1(A) This shows the large symmetrical confluent yellow plaque over the nasal bridge extending to both cheeks, with a similar yellow plaque over the left upper eyelid; (B) shows the right side of the face with a yellow plaque over the right earlobe rim; (C) shows the left earlobe after 1 session of carbon dioxide laser treatment, with significant textural improvement and no significant scarring; (D) shows the right earlobe after one session of 1064-nm Nd: YAG treatment, with residual erythema, depression and scarring noted.
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