Leonine facies in an old man

Early leonine facies with alopecia in a young man

“…Multiple small tumor cell aggregates closely distributed in large areas of superficial and deep dermis might be responsible for diffuse appearance of the lesion covered with thick shiny wrinkle free skin. Hair loss and leonine facies are features described in lepromatous leprosy . No nerve thickening was seen in our case, there was no sensory or motor loss, and slit‐skin smear was negative for acid‐fast bacilli, excluding lepromatous leprosy.…”

“…Hair loss and leonine facies are features described in lepromatous leprosy. 4 No nerve thickening was seen in our case, there was no sensory or motor loss, and slit-skin smear was negative for acid-fast bacilli, excluding lepromatous leprosy. Scleromyxedema was considered as a differential diagnosis of leonine facies with waxy infiltration, but absence of monoclonal proteins in serum and urine electrophoreses and absence of mucoid material and proliferating fibroblasts in dermis excluded scleromyxedema as a cause of leonine facies in our case.…”

Multiple familial trichoepitheliomas presenting as leonine facies

“…Apart from leprosy, leonine facies have been reported in cutaneous sarcoidosis, leishmaniasis, mastocytosis, actinic reticuloid, scleromyxedema, hematological malignancies, mycosis fungoides, leukemia cutis, and various other diseases [ Table 1 ]. [ 1 2 3 4 5 6 7 8 9 10 11 12 ]…”

“…Trichoepithelioma is a benign tumor of folliculosebaceous origin. [ 3 ] It was first described by Brooke and Fordyce in 1892. [ 3 ] The name trichoepithelioma is preferable to other designations, such as epithelioma adenoides cysticum and multiple benign cystic epithelioma, because it is more suggestive of the differentiation of this tumor towards hair structures.…”

“…Lesions increase in size with age, may coalesce to form large lesions, occasionally giving rise to a leonine appearance to the face. [ 3 ] Telangiectasia can be seen on the surface of the larger lesions resembling basal cell carcinoma (BCC). In contrast to BCC, ulceration is very rarely present in trichoepithelioma.…”