Just Another Day in Derm: Dr Pimple Popper

Case #1: A nice Dilated Pore of Winer on the upper arm of one of my long standing sassy patients.
A Dilated pore of Winer is essentially a large, solitary open comedone/blackhead. Dead skin cells get trapped and help widen this pore, and plugs up the opening. The expression of this plug squeezes out the macerated, white, soggy keratin/skin cells from the deeper portion of the pore. Once the content of the dilated pore is expressed, this whole process of the dilated pore filling once again with keratin is common. They are completely benign and are usually expressed for cosmetic reasons. A comedone extractor can be used to do this.

Case #2: A stubborn milium close to my patent’s eye
A milium (single for milia) is a small superficial cyst formed in the top layer of the skin called the epidermis. They appear as tiny, pearly-white bumps just under the surface of the skin. They contain keratin (skin protein) and are harmless. They are often seen on the face, in particular on the delicate skin around the eyes. They can be prevented or minimized with exfoliating like chemical peels, microdermabrasion or topical retinoids. However, they are sometimes difficult to remove without a physician’s help, since they cannot simply be squeezed out. Often, the surface of the skin has to be pierced first with a lancet, a sharp pointed blade, or a needle, in order to successfully remove the milium. Often a comedone extractor is used to express the milium.

Case #3: Guttate-type psoriasis. Biopsy was done here to confirm diagnosis.
This patient I believe was misdiagnosed previously. She came to see me, telling me that she had a condition called Pityriasis Lichenoides Chronica (PLC, for short). When I took a look at her, I didn’t think this is what her lesions looked like, clinically. I asked her if she had a recent cold/bacterial infection, and she did report that she had a sore throat and a cold that she was still recovering from. This was a clue to a diagnosis. Biopsy confirmed that she has guttate psoriasis. This is a particular subtype of psoriasis, also called eruptive psoriasis. “Guttate” is Latin for tear drops. It’s as if drops of water landed on her skin to create these bumps. It’s common to see these small round papules erupt all of a sudden on the trunk and the proximal extremities (the parts of the arms and legs closest to the center of your body).
Guttate psoriasis is classically triggered by a bacterial infection, usually an upper respiratory tract infection, like strep throat
After the throat infection has cleared up the person can feel fine for several weeks before noticing the appearance of red spots. They appear small at first, like a dry red spot which is slightly itchy. When scratched or picked the top layer of dry skin is removed, leaving dry, red skin beneath with white, dry areas marking where flakes of dry skin stop and start. Treatment is often with topical corticosteroids. She will do great and will likely clear completely with a prescription cream/ointment. Other types of psoriasis are more chronic and lifelong. It’s important to know that this condition is NOT contagious and NOT life-threatening.

Case #4: I initially thought this was an epidermoid cyst, but is was more chalky and hard… this was a pilomatricoma. Looking back, I would have rescheduled this for a later date, because I would have had more time to remove this bump. Pilomatricomas are often more adherent and not as “simple” to remove as an epidermoid cyst. Thankfully, she was very tolerant of my fussing with her and I was able to remove the entire lesion during this visit.
A Pilomatricoma (aka Calcifying Epithelioma of Malherbe, or pilomatrixoma) is a benign growth derived from hair matrix cells. Usually occurs as a single lesion on the face, neck or upper arms. They cause no pain, but are firm bumps under the skin. The diagnosis is usually made only after looking at the tissue under the microscope. We look for “shadow cells” under the microscope. Calcification and ossification can occur (calcium and bone can develop within) which can make these very firm and hard, much like a pebble or little jagged rock under the skin. These are benign and don’t need to be removed, but if someone requests removal, a surgical excision is needed.

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Periscope: Dr. Sandra Lee

This video may contain dermatologic surgical and/or procedural content. The content seen in this video is provided only for medical education purposes and is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

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