Different facies found in different disease

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By looking at the patient’s face, many clinical diagnoses are possible. Some examples are given
below—
• Myxoedematous face—patient looks apathetic, face is puffy with periorbital swelling, baggy
eyelids with loss of outer 1/3rd of the eyebrows. There may be malar flash.

• Cretinism—idiotic look, coarse face with thick lips, large ears.

• Thyrotoxic face or Graves’ disease—bilateral or unilateral exophthalmos, the patient looks
anxious, restless and fidgety. Thyroid gland is diffusely enlarged.

• Cushingoid face—rounded, plethoric face giving rise to moon face appearance, also hirsut-
ism and acne.

• Acromegalic face—coarse facies, prominent supraorbital ridges, increased wrinkling of the
forehead. Mandible, nose, lips and ears are large.

• Mongoloid face (Down’s syndrome)—flat nasal bridge, low set small ears, mouth appears
small and tends to remain open. Tongue appears protruding with large, horizontal fissure.
• Haemolytic face—frontal and parietal bossing with prominent malar bones.

• Leonine face (in lepromatous leprosy)—skin of the face and forehead is thick and corrugated.
Multiple nodules of variable sizes and shapes involving ear lobule, face and nose.

• Parkinsonian face—mask like, expressionless face with less blinking of the eyes, staring look
and dribbling of saliva.

• Marfanoid face—face is long, lean, elongated and narrow.

• Mitral facies—malar flush.

• Myopathic face—frontal baldness, long, lean, triangular, sad and expressionless face with
wasting of temporalis and masseter.

• Nephrotic face—puffy with periorbital swelling.

• Achondroplasia—skull appears enlarged.

• Superior vena caval (SVC) obstruction—puffy, oedematous, plethoric face with congested
conjunctival vessels (blood shot eyes) and engorged nonpulsatile neck vein.

• Sturge–Weber’s syndrome—port wine stain.

• Hepatic facies—muddy or pigmented discolouration, pinched face and sunken eyes, promi-
nent malar bones.

• Hippocratic face (in advanced peritonitis)—pinched nose, sunken eyes, collapsed temples,
with crust on lips and clammy forehead.

• Psychiatric disorders—depressed or anxious face.

• Butterfly rash—photosensitive rash over both cheeks and bridge of the nose.

• Systemic sclerosis—smooth, shiny, tight with hypopigmented and hyperpigmented areas.
Nose is pinched up and tapered (beaking of nose, bird beak), loss of wrinkling of forehead.
Lips are thin, pursed with puckering of the skin around mouth. Orifice of mouth is small (microstomia).

• Myasthenic face—ptosis, usually bilateral, may be unilateral with frontalis over activity.

• Turner’s face—short and webbed neck, low hairline and redundant skinfold on the back of
neck. Small lower jaw (micrognathia), small and fish-like mouth with low set, deformed ears.
• Bilateral parotid enlargement.
• Virile (virilization in female).
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