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Facial expression
Last reviewed: 05.07.2025
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Facial expression depends not only on the patient's mental state, but also on the skin color associated with various cytological processes, the appearance of the eyes, nose, lips, teeth, cheeks, and the presence of rashes. In a number of diseases, the face acquires a characteristic appearance.
A suffering facial expression is possible in patients with severe, unbearable pain.
There is a well-known clinical triad - the "Hippocratic face" (facies Hippocratica): with a suffering expression, gray, with sharpened features, sunken eyes, large drops of cold sweat on the forehead, which is often observed in patients with severe peritonitis.
In advanced heart disease, a puffy (edematous) face with a bluish and sometimes yellowish discoloration of the skin, purple lips, and an open mouth gasping for air is observed.
The face of patients with pulmonary tuberculosis: against the background of general pallor, bright red spots of blush on the cheeks, wide-open eyes, dry lips. A constant bright blush of the cheeks, making patients look younger than their age, is observed in mitral valve disease (for example, rheumatic stenosis of the mitral orifice).
In kidney disease, the face may be severely swollen, especially around the eyelids, against a background of pale skin. These changes often make the patient's face unrecognizable.
The face changes noticeably in various endocrine diseases: Cushing's syndrome, myxedema, acromegaly, hyperthyroidism. Exophthalmos or exophthalmos, i.e. displacement of the eyeballs forward, accompanied by widening of the palpebral fissure, is a typical external sign of hyperthyroidism.
Mask-like face, disappearance of facial expressions, appearance of folds around the nose like a purse string are observed in systemic scleroderma. A characteristic mask-like face was described by I.S. Turgenev in "Notes of a Hunter". A peculiar face - paraorbital edema with bright hyperemia - is noted in patients with dermatomyositis. Manifestations of systemic lupus erythematosus can be erythematous rashes in the cheeks and bridge of the nose, resembling a butterfly.
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