Unusual Presentation of Facial Comedones

Not all facial comedonal lesions represent acne, nor are they always benign. A lack of response to standard acne treatments should prompt clinicians to reconsider the diagnosis and explore more serious conditions, such as <i>comedonal lupus erythematosus</i>, <i>folliculotropic lymphoma</i>, or <i>acneiform syphilis</i>. Recognizing these conditions can significantly impact patient management.