Mandibular Area and Neck

Mandibular Area and Neck


Many of the conditions seen on the chin and neck represent an extension of disorders found on the face, scalp, or trunk. Acne, folliculitis, and pityriasis rosea are common examples. Benign neoplasms such as skin tags, small seborrheic keratoses, and acanthosis nigricans also frequently appear on the neck.

On the chin and neck, folliculitis barbae (“shaving bumps”) and acne lesions present problems for men who shave. Pseudofolliculitis barbae (PFB) is especially a challenge for black men. The chin, beard area, and neck are also subject to bacterial (staphylococcal folliculitis) and, less frequently, fungal (sycosis barbae) and viral folliculitis (herpetic) infections. The beard is also a common site for alopecia areata to appear in men.

The area under the chin and other shaded areas, such as those covered by long hair, are shielded from chronic sun exposure and are generally spared from sun-related disorders and malignant neoplasms. Basal cell carcinomas and squamous cell carcinomas, when they do arise on the neck, usually occur in men in areas that are chronically sun-exposed—the nape, “V,” and lateral neck.

Acne keloidalis nuchae, a disorder that appears most often in black men, is noted on the posterior neck and occipital area. The posterior neck is also often a focus for chronic pruritus and lichen simplex chronicus.

Furuncle (“Boil”)/Carbuncle

Distinguishing Features

  • Gradually a subcutaneous nodule becomes fluctuant and develops central suppuration (Fig. 10-1)

  • Often quite tender

  • Carbuncles are furuncles with multiple “heads” (Fig. 10-2)

Odontogenic Sinus

Distinguishing Features

  • May present as a persistent, painless draining furuncle-like papule with or without an overlying crust (Fig. 10-3)

Poikiloderma of Civatte

Distinguishing Features

  • Most commonly occurs in middle-aged or elderly females

  • Erythema associated with a mottled hyperpigmentation located on the sides, and “V” of the neck (sun-exposed areas) (Fig. 10-4)

  • The term poikiloderma refers to a change in the skin where there is thinning, increased pigmentation, and dilation of the fine blood vessels (telangiectasia)

  • The shaded submental and submandibular areas are spared

Polymorphous Light Eruption

Distinguishing Features

  • Usually seen in women

  • On different patients, lesions may be papules (most common), papulovesicles, erythematous plaques, erythema multiforme-like, or purpuric

  • Usually only one morphology dominates in a given individual

  • The rash appears within hours to days of exposure, and it subsides over the next 1 to 7 days

  • The areas of greatest involvement are the “V” areas of the neck and chest (Fig. 10-5) and particularly the extensor surfaces of the arms. Curiously, the face is usually spared

  • Most patients experience pruritus, while others describe stinging and pain

  • Typically, the lesions of PMLE first erupt with the first seasonal exposure to the sun and disappear gradually over time

Jan 8, 2023 | Posted by in Dermatology | Comments Off on Mandibular Area and Neck

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