What is the cause of a chronic unilateral erythematous (red) cheek with a darker center in a toddler?

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Differential Diagnosis for Chronic Unilateral Red Cheek with Darker Center in Toddler

  • Single most likely diagnosis
    • Slapped cheek syndrome (Erythema infectiosum): This is a common childhood illness caused by parvovirus B19, characterized by a distinctive "slapped cheek" appearance with a red rash and a pale center, although the description of a darker center may vary.
  • Other Likely diagnoses
    • Contact dermatitis: This is a type of skin inflammation caused by contact with irritants or allergens, which could result in a red, unilateral cheek rash.
    • Atopic dermatitis (eczema): Although typically bilateral, atopic dermatitis can sometimes present unilaterally, especially if triggered by an external factor.
    • Impetigo: A contagious skin infection that can cause red, crusty patches on the face, potentially with a darker center due to crusting.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
    • Cellulitis: A bacterial skin infection that can cause redness, swelling, and warmth, potentially with a darker center due to necrosis or abscess formation.
    • Meningococcemia: A severe infection caused by Neisseria meningitidis, which can present with a petechial or purpuric rash, although this is typically more widespread.
  • Rare diagnoses
    • Lupus miliaris disseminatus faciei: A rare form of cutaneous lupus that can cause reddish-brown papules on the face, potentially with a darker center.
    • Sarcoidosis: A systemic disease that can cause skin lesions, including those on the face, although this is rare in toddlers.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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