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Accompanied by family, a 68-year-old man presents for evaluation of changes on the left side of his face. His relatives, who have not seen him in years, find the changes quite alarming; the patient, however, is quite sure he has “looked this way for a while.” In any case, he has no associated symptoms.
He does have numerous other health problems, including hypertension, heart disease, and a 50–pack-year history of smoking. He has spent a great deal of time in the sun over the years, particularly when he drove a dump truck for work.
EXAMINATION
The left side of the patient’s face is covered with open and closed comedones superimposed on thickened, yellowed skin. Poikilodermatous changes and multiple telangiectasias can also be seen. The right side of his face demonstrates minor skin changes relative to the left.
What is the diagnosis?
These changes represent Favre-Racouchot syndrome (FRS). First described by Favre in 1932, the syndrome was refined in 1951 when Favre and Racouchot noticed its prevalence in truck drivers who also smoked. In France at that time, more than 80% of truck drivers were smokers—and they got the most sun exposure on the left sides of their faces. The condition was later identified in fishermen and other outdoor workers.
Studies in the US show that FRS affects nearly 6% of white adults (usually men) older than 60. Radiation therapy (eg, for squamous cell carcinoma) can produce similar effects.
Needless to say, smoking cessation is advisable. Beyond that, treatment involves preventing further sun damage and applying retinoid preparations, such as tretinoin or adapalene. Depending on the desired level of improvement, comedones may need to be surgically ablated.
TAKE-HOME LEARNING POINTS
• Favre-Racouchot syndrome (FRS) manifests with collections of open and closed comedones on sun-damaged facial skin.
• Most FRS patients are white male smokers older than 60.
• FRS is usually unilateral, resulting from overexposure to sunlight through a vehicle’s driver-side window; however, people working outdoors (eg, fishermen) can develop it over the whole face.
Accompanied by family, a 68-year-old man presents for evaluation of changes on the left side of his face. His relatives, who have not seen him in years, find the changes quite alarming; the patient, however, is quite sure he has “looked this way for a while.” In any case, he has no associated symptoms.
He does have numerous other health problems, including hypertension, heart disease, and a 50–pack-year history of smoking. He has spent a great deal of time in the sun over the years, particularly when he drove a dump truck for work.
EXAMINATION
The left side of the patient’s face is covered with open and closed comedones superimposed on thickened, yellowed skin. Poikilodermatous changes and multiple telangiectasias can also be seen. The right side of his face demonstrates minor skin changes relative to the left.
What is the diagnosis?
These changes represent Favre-Racouchot syndrome (FRS). First described by Favre in 1932, the syndrome was refined in 1951 when Favre and Racouchot noticed its prevalence in truck drivers who also smoked. In France at that time, more than 80% of truck drivers were smokers—and they got the most sun exposure on the left sides of their faces. The condition was later identified in fishermen and other outdoor workers.
Studies in the US show that FRS affects nearly 6% of white adults (usually men) older than 60. Radiation therapy (eg, for squamous cell carcinoma) can produce similar effects.
Needless to say, smoking cessation is advisable. Beyond that, treatment involves preventing further sun damage and applying retinoid preparations, such as tretinoin or adapalene. Depending on the desired level of improvement, comedones may need to be surgically ablated.
TAKE-HOME LEARNING POINTS
• Favre-Racouchot syndrome (FRS) manifests with collections of open and closed comedones on sun-damaged facial skin.
• Most FRS patients are white male smokers older than 60.
• FRS is usually unilateral, resulting from overexposure to sunlight through a vehicle’s driver-side window; however, people working outdoors (eg, fishermen) can develop it over the whole face.
Accompanied by family, a 68-year-old man presents for evaluation of changes on the left side of his face. His relatives, who have not seen him in years, find the changes quite alarming; the patient, however, is quite sure he has “looked this way for a while.” In any case, he has no associated symptoms.
He does have numerous other health problems, including hypertension, heart disease, and a 50–pack-year history of smoking. He has spent a great deal of time in the sun over the years, particularly when he drove a dump truck for work.
EXAMINATION
The left side of the patient’s face is covered with open and closed comedones superimposed on thickened, yellowed skin. Poikilodermatous changes and multiple telangiectasias can also be seen. The right side of his face demonstrates minor skin changes relative to the left.
What is the diagnosis?
These changes represent Favre-Racouchot syndrome (FRS). First described by Favre in 1932, the syndrome was refined in 1951 when Favre and Racouchot noticed its prevalence in truck drivers who also smoked. In France at that time, more than 80% of truck drivers were smokers—and they got the most sun exposure on the left sides of their faces. The condition was later identified in fishermen and other outdoor workers.
Studies in the US show that FRS affects nearly 6% of white adults (usually men) older than 60. Radiation therapy (eg, for squamous cell carcinoma) can produce similar effects.
Needless to say, smoking cessation is advisable. Beyond that, treatment involves preventing further sun damage and applying retinoid preparations, such as tretinoin or adapalene. Depending on the desired level of improvement, comedones may need to be surgically ablated.
TAKE-HOME LEARNING POINTS
• Favre-Racouchot syndrome (FRS) manifests with collections of open and closed comedones on sun-damaged facial skin.
• Most FRS patients are white male smokers older than 60.
• FRS is usually unilateral, resulting from overexposure to sunlight through a vehicle’s driver-side window; however, people working outdoors (eg, fishermen) can develop it over the whole face.
