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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 1700! You can review the archived cases and read the suggested diagnoses by users and the final comment by Dr Uma Sundram, the Editor-in-Chief and main spot diagnosis host. Case are uploaded each week day by 10 a.m. UK time with the correct diagnosis will generally be posted at 8 p.m. UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

Case Number : Case 1187 - 9th January Posted By: Guest

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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F60. Bilateral periorbital swelling. Case courtesy of Dr Nick Tiffin, Sheffield, UK.

Case posted by Dr Richard Carr


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Eman El-Nabarawy

Posted

Hyaluronic acid filler. I think BioAlcamid is more violacous.

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Dr. Mona Abdel-Halim

Posted

Yes filler material mostly hyaluronic acid

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Dr. Richard Carr

Posted

You all agreed with my first thought on the case but that is not the answer.

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Eman El-Nabarawy

Posted

Mucinosis? Periorbital scleredema.

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Dr. Mona Abdel-Halim

Posted

Now, if this is not hyaluronic acid filler, then this is mucin. F60, bilateral periorbital swelling makes me think that this lady is myxedematous and this is periorbital myxedema.

http://www.ncbi.nlm.nih.gov/pubmed/2909069 but unfortunately no abstract is available :-(

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Guest Jim Davie MD

Posted

If it is a nodular mucinosis with bilateral periorbital distribution, I'd also think of tumid lupus. The latter may sometimes lack any epidermal or dermal inflammatory reaction (as seems to be the case here).

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Guest Romualdo

Posted

If this blue substance is mucin, I go with periorbital mucinosis, considered a variant of lupus erythematosus. In the absence of any dermal lymphocitic infiltrate with perivascular distribution I think this is a better diagnosis to this case than lupus tumidus.

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Mark A. Hurt MD

Posted

Favor Restylane® filler. http://www.restylaneusa.com

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I misread periorbital as "perioral". In this case, I'm with lupus.

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Dr. Richard Carr

Posted

Apologies for delay this was a busy morning. This was a rare case of peri-orbital mucinosis associated with lupus. Well done!! Thanks again to Dr Tiffin for allowing me to share this case with you all.

Morales-Burgos A, Sánchez JL, Gonzalez-Chávez J, Vega J, Justiniano H. Periorbital mucinosis: a variant of cutaneous lupus erythematosus? J Am Acad Dermatol. 2010 Apr;62(4):667-7

Author information 1Department of Dermatology, School of Medicine, University of Puerto Rico, San Juan, Puerto Rico. [email="adismorales@yahoo.com"]adismorales@yahoo.com[/email]

Abstract
Lupus erythematosus has a wide spectrum of cutaneous manifestations, including periorbital mucinosis. We report 3 cases of periorbital mucinosis occurring in association with other cutaneous signs of lupus erythematosus. Based on a review of the literature, periorbital mucinosis is a rare and not widely recognized clinical manifestation of the disease. Although unusual, familiarity with periorbital mucinosis as a manifestation of lupus erythematosus broadens our understanding of these entities and expands the spectrum of cutaneous lupus erythematosus.

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