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Facial rashes

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
Face: erosions/scabs

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Herpes Simplex

figure-37-face__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildbd-8759833-5960316

Herpes infection

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Impetigo

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)
Face: scaly rash

figure-40-face__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-7859248-2927082

Atopic eczema

figure-44-face__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildbd-4836602-3047097

Psoriasis

figure-45-face__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-8305104-5713693

Seborrheic dermatitis

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
Face: localized areas of dermatitis.

figure-39-face__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildbd-4897127-6145964

allergic contact eczema

figure-41-face__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-3766585-2601028

irritant contact eczema

figure-42-face__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-3282162-5844401

photosensitive dermatitis

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

figure-258-face__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-3119558-1123628

Actinic keratosis

figure-35-face__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingilde5xq-8017185-3124137

Tinea faciei

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Tinea faciei

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
Cutaneous lupus erythematosus

figure-43-face__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-1928853-6450407

Discoid lupus erythematosus

figure-54-face__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingilde5xq-6325436-3821014

Lupus tumidus / Jessner's lymphocytic infiltrate

papulopustular eruption

Acne

figure-31-face__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-3504211-8932568

Acne

figure-48-face__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildbd-3882343-4742199

Closed comedones

  • 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.
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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: follicular eruption

figure-32-face__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-1286103-5342028

Perioral / periorificial dermatitis

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Pseudofolliculitis of the beard

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Rosacea

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.
Face: erythema

figure-55-face__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-8989779-3736920

Dermatomyositis

figure-56-face__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-1606563-7123797

Redness

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Sun tanning

Systemic lupus erythematosus

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

Telangiectasia

  • May accompany redness
  • Vascular dilatation
  • Various types

figure-58-face__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisinkildg1xq-1044551-9175915

Systemic LE

figure-59-face__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisinkildg1xq-4452339-7668652

Telangiectasia

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
  • Borde distintivo, a veces rojo al principio

Melasma

  • Generalmente hembra adulta
  • Centrofacial malar y patrones mandibulares
  • Repuestos de párpados, poco frecuentes debajo de la línea de la mandíbula
  • Pigmentación simétrica con borde irregular

Post-inflammatory pigmentation

  • Eccema anterior, psoriasis, acné, etc.
  • La distribución depende de la causa.
Face: brown patches

figure-60-face__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildbd-1500217-9005572

Erythema dyschromicum perstans

figure-61-face__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildbd-2092099-7122635

Melasma

figure-62-face__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildbd-4166070-8382079

Pigmentación posinflamatoria

Face: pale or white macules/patches

Guttate hypomelanosis

  • Más comúnmente observado en las extremidades

Pityriasis Sunrise

  • Little boy
  • Las mejillas
  • Hypopigmentation, escala de luz
Face: pale patches

figure-63-face2__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildbd-8824128-9402199

Guttate hypomelanosis

figure-64-face2__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-2509980-5493960

Pitiriasis alba

Hipopigmentación posinflamatoria

  • Eccema anterior, psoriasis, acné, etc.
  • La distribución depende de la causa.

Vitiligo

  • Muy a menudo periocular, perioral
  • Superficie blanca y lisa
Face: white spots

figure-65-face__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-7571509-3919843

Hipopigmentación posinflamatoria

figure-66-face__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-6932680-3052316

Vitiligo

Skin lesions

Granuloma facial

  • Adulto de mediana edad
  • Placa o placas solitarias, espesas, lisas, de color marrón violáceo

Sarcoidosis

  • Placa infiltrada de color marrón amarillento a malva
  • Puede surgir dentro de los existentes scar
  • El lupus pernio afecta la nariz y las orejas.

Sebaceous hyperplasia

  • Mayormente> 40 años
  • Frente, templos
  • Pápulas amarillentas con hoyuelo folicular central.
Face: papules and plaques.

figure-50-face__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildbd-6400131-8866108

Sebaceous hyperplasia

figure-52-face__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisinkildg1xq-9372917-8369852

Facial granuloma

figure-53-face__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-7350501-9327738

Sarcoidosis

solar comedones

  • Fumador, paciente mayor dañado por el sol
  • Periocular, pómulos, nariz, cuello.
  • Generalmente simétrica

Basal cell carcinoma

  • Ampliación lenta, destructiva papule, nodule o placa
  • Early erosion, ulceration and bleeding

Scaly cell carcinoma

  • Agrandamiento del nódulo escamoso o con costras
Face: lesions

figure-260-face3__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisinkildq1xq-3236712-3090028

solar comedones

figure-261-face__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-3627964-9060107

Basal cell carcinoma

figure-262-face__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-8592167-1442137

Squamous cell carcinoma

Annexed tumors

  • Varios tipos y síndromes
  • Folicular o eccrine origen

Milia

  • Periorbital o mejillas
  • Firme superficial pápulas pequeñas
  • Esparcidos en la frente, mejillas
  • Amarillento con dell central
Face: multiple papules

figure-47-face__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-9851952-5506022

Birt-Hogg-Dubé syndrome

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Milia