The FP recognized the dark line on the patient’s face as a hyperpigmented horizontal nasal crease based on the fact that she had the atopic triad and repeatedly wiped her nose in an upward motion (an “allergic salute”) whenever her nose felt itchy. There is no specific treatment for a hyperpigmented horizontal nose crease, except to help control the allergic rhinitis. It also helps to control any atopic dermatitis, which can lead to pruritus.
The patient was happy to know the cause of the condition and did not request treatment for the cosmetic aspect of it. For patients who want treatment, a good place to start is with an over-the-counter 3% hydroquinone bleaching agent, along with 1% hydrocortisone cream. (These can both be applied twice daily.)
The FP in this case also recommended sun protection and sun avoidance to avoid further darkening of the hyperpigmented crease.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Usatine R, Finklea L. Atopic dermatitis. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:584-590.
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