Evaluation of Darkening Forehead Lesion, Acne, and Rosacea in a 37-Year-Old Female — Village Dermatology, Katy & Houston, Texas

Patient Overview

A 37-year-old female presented to Village Dermatology as a new patient with a primary concern of a skin lesion on the right forehead. The lesion had been darkening and enlarging over several months and had not received prior treatment. She sought full evaluation and guidance on management.

A comprehensive skin exam was performed, including dermatoscopic evaluation of the face, scalp, and upper extremities. The patient appeared well-nourished, alert, and in no acute distress.

Clinical Findings

1. Acne 

Examination revealed comedonal papules, inflammatory papules, and pustules distributed across the face, consistent with mixed acne (inflammatory + comedonal).

2. Rosacea

The patient also exhibited erythematous papules and pustules, facial redness, and features consistent with rosacea, especially sensitivity to heat, sun, spicy foods, and alcohol.

3. Dermatofibroma

A firm, scar-like nodule was noted on the right pretibial region, consistent with a dermatofibroma, a benign skin growth.

Treatment & Management

1. Acne Management

The patient was counseled extensively on acne triggers, skincare, and expected outcomes.

Counseling Overview:

• Use only non-comedogenic cleansers, moisturizers, and cosmetics

• Acne improvement typically takes 2–3 months, with a 60–80% improvement expected with consistent care

• Avoid picking or squeezing lesions to prevent scarring

Recommendations:

• Daily broad-spectrum sunscreen SPF 30+

• Non-comedogenic moisturizers

2. Rosacea Treatment

The diagnosis of rosacea was reviewed in detail. The patient was educated on known triggers, including:

• Sun exposure

• Heat

• Spicy foods

• Alcohol

• Stress

• Exercise

• Masks or wind exposure

She was advised to avoid topical steroids on the face, as these can worsen rosacea.

Treatment Initiated:

• Azelaic acid topical therapy, applied once daily

• Green-tinted moisturizers may help neutralize redness

• Strict SPF 30+ sunscreen use daily

Long-Term Outlook:

Rosacea is chronic, but flare-ups can be well-managed with lifestyle adjustments and topical therapy.
Laser therapy may help reduce telangiectasias.

3. Dermatofibroma

The dermatofibroma on the lower leg was reviewed with reassurance.

Counseling:

• Dermatofibromas are benign and do not pose danger

• Surgical removal is optional and typically reserved for symptomatic lesions (pain, irritation, growth)

No treatment was needed at this time.

Forehead Lesion

Although the case narrative does not specify the diagnosis for the darkening, enlarging forehead lesion, it was closely examined using a dermatoscope. The absence of a biopsy plan in the medical note suggests no immediate suspicion for malignancy; however, monitoring or follow-up may be needed depending on evolution.

Follow-Up

The patient was instructed to contact the office if:

• Acne or rosacea worsens

• New nodules or cysts appear

• Any lesion changes rapidly in size, shape, or color

• The forehead lesion continues to darken or enlarge

She will begin her new treatment regimen and follow up as needed.

🌟 Takeaway

This case highlights the complexity of diagnosing and treating overlapping dermatologic conditions such as acne, rosacea, and benign lesions, while also addressing concerns about a new darkening skin lesion.
At Village Dermatology in Katy and Houston, Texas, we provide comprehensive evaluation and customized treatment plans for patients with multi-layered skin concerns.