The face as a mirror of disease

A fascinating aspect of the art of clinical medicine is the clinical interpretation of the patient's facies. Not only are specific skin lesions common on the face but the face may also mirror endocrine disorders and organ failure such as respiratory, cardiac, renal and liver failure. Jaundice may be masked by the natural colour of the cheeks but the yellow conjunctivae will be distinctive. A marked plethoric complexion may be seen in chronic alcoholics (alcohol may produce a pseudo-Cushing's syndrome), in Cushing's disease or in polycythaemia. Thickening of the subcutaneous tissues may be seen in chronic alcoholism, acromegaly and myxoedema, and the puffiness of the eyelids in the latter condition may simulate the true subcutaneous oedema of renal disease.

An individual's personality and mood rarely fail to leave an impression on the facial characteristics. This is partly due to the alteration in facial lines and wrinkles, which may become modified in anger, irritability, anxiety and stress. More profound changes occur with mental disease. Various CNS diseases such as Parkinson's disease and myopathies can affect facial expression, e.g. the immobile face of the patient with Parkinson's disease.

The appearance of the eyes can also be very significant and may reflect underlying systemic disease.

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