Facial rashes

Patients often present with fairly mild signs when they have a facial injury or eruption – due to embarrassment – and diagnosis can be tricky.

Significant itching suggests atopic dermatitis or contact dermatitis.

Expensive: erosions/ /crust

Herpes Simplex

• Monomorphic grouped vesicles or crusted papules
• often locally recurrent At the same place
• Swabs: Herpes simplex

Herpes infection

• Acute dermatomal eruption
• Painful: pain may precede the rash
• Erythema can precede vesicles
• Swabs: Shingles

Impetigo

• Irregular enlargement license plate
• honey-colored crusts
• Swabs: Staphylococcus aureus +/- Streptococcus pyogenes

dry or scaly eruption

Seborrheic dermatitis

• Often also affects the scalp, postauricular sites, ears
• hairline, eyebrows, medium cheeks, nasolabial folds, chin wrinkles
• Squamous blepharitis
• Ill-defined, white or variable yellowish scales
• Can have erythematous patchy or thin plates
• Follicular follicular prominence or digitate keratosis

Psoriasis

• Eyelids, temples, retro and preauricular skin, and/or sites of seborrheic dermatitis
• It also affects the scalp, ears, elbows, knees, nail
• Well-demarcated erythematous plaques
• White scale
• More persistent than seborrheic dermatitis

Atopic eczema

• It often affects push-ups: retroauricular folds, elbows and knees
• Symmetrical eyelid dermatitis, perioral skin (up to the lips)
• intense itching
• Sharp flare: edemaerythema, crusts fissure
• Subacute: dry, pinkish
• Chronic: dryness, lichenification, Dennie Morgan creases (2 lower lid creases)

contact eczema

• Acute, recurrent/intermittent or chronic presentation.
• uneven, variable, unilateral or asymmetric dermatitis
• Sharp edge if contact irritating dermatitis
• Patch positive if contact allergy

Photosensitive dermatitis

• Exposed areas of face, arms, chest, legs.
• spare parts under hair, eyelids, folds
• Flashes after outdoor exposure
• Can be drug induced

Tinea faciei

• asymmetric eruption
• Cancel setting It is common
• scaly border
• positive mycology

Actinic keratosis

• Located in temple sites exposed to the sun, forehead, nose, cheekbones, jaw angle, upper lip, lower vermilion lip
• Persistent and tender scaly papules, maculesplates

Cutaneous lupus erythematosus

Discoid lupus erythematosus

• Nose, cheeks, ears, lips, scalp
• Circumscribed plaques with follicular prominence, scale
• Send-inflammatory pigmentation, atrophic scars
• CBC, ANA, ENA often normal

Lupus tumidus / Jessner lymphocytic infiltrate

• Cheeks, upper trunk
• Smooth to erythematous surface dermal plates

papulopustular eruption

Acne

• Onset often at puberty
• Usually symmetrical forehead, chin, side face nose
• Mixed inflammatory and non-inflammatory lesions
• papules, pustules, nodules, comedones

Oral /periorificial dermatitis

• Adult women usually wear expensive cream, often current corticosteroid
• Often asymmetric first at perioral sites, then at perinasal and periocular sites
• Save an inch of skin around the vermillion lips
• grouped erythematous papules and pustules in erythematous patches, scaly surface
• It can occur in children.

Rosacea

• Plus predominant in middle-aged adults
• Medium facial: cheeks + nose, chin and forehead
• Erythema, redness, papules, pustules, telangiectasia
• Rhinophyma causes enlargement of the nose in some patients.
• Sensitive skin
• Lesions may approach the lips.

Pseudofolliculitis of the beard

• Acne
• Follicular papules, pustules, curly hair.

Face: erythema

The erythema is less pronounced on dark skin.

Dermatomyositis

• Violaceous eyelids – may be swollen
• Poikiloderma on the trunk and extremities
• Gottron's papules on the fingers
• You may have muscle weakness.

Redness

• Intermittent redness when hot, embarrassed, or with certain foods.
• Often lifelong trend
• systemically well
• Associated with rosacea

Sun tanning

• site exposed to the sun
• Spare eyelids, furrows, under the chin.

Systemic lupus erythematosus

• Erythematous butterfly rash
• Systemic symptoms: tiredness, lethargy, arthralgia
• Check CBC, ANA, ENA

Telangiectasia

• May accompany redness
• Vascular dilatation
• Various types

Face: brown macules/patches

Pigmentation is more pronounced on dark skin.

Solar lentigines

• Sun-exposed sites
• small to large freckles
• Well-defined flat or slightly scaly brown marks or thin plaques

Erythema dyschromicum perstans

• Gray-brown discoloration
• None distribution
• Distinctive border, sometimes red at first

Melasma

• Usually adult female
• Centrofacial malar and mandibular patterns
• Eyelid replacements, rare below the jawline
• Symmetrical pigmentation with irregular border

Post-inflammatory pigmentation

• Previous eczema, psoriasis, acne, etc.
• The distribution depends on the cause.

Face: pale or white macules/patches

Guttate hypomelanosis

• Most commonly seen on the extremities

Pityriasis Sunrise

• Little boy
• Cheeks
• Hypopigmentation, light scale

Post-inflammatory hypopigmentation

• Previous eczema, psoriasis, acne, etc.
• The distribution depends on the cause.

Vitiligo

• Most often periocular, perioral
• White and smooth surface

Skin lesions

Granuloma facial

• Middle aged adult
• Solitary, thick, smooth, purplish-brown plaque or plaques

Sarcoidosis

• Yellowish brown to mauve infiltrated plaque
• It can arise within the existing scar
• Lupus pernio affects the nose and ears.

Sebaceous hyperplasia

• Mostly > 40 years
• Front, temples
• Yellowish papules with central follicular dimple.

solar comedones

• Smoker, sun damaged elderly patient
• Periocular, cheekbones, nose, neck.
• Generally symmetrical

Basal cell carcinoma

• Slow, destructive expansion papule, nodule or plate
• Early erosion, ulceration and bleeding

Scaly cell carcinoma

• Enlarged scaly or crusty nodule

Annexed tumors

• Various types and syndromes
• Follicular or eccrine origin

Milia

• Periorbital or cheeks
• Firm superficial small papules
• Scattered on the forehead, cheeks
• Beige with central dell