Differential Diagnosis for Red Area on Cheek with Painful White Pustule
Single Most Likely Diagnosis
- Acne Vulgaris: Given the description of a red area with a white pustule in the middle, acne vulgaris is a highly likely diagnosis. The presence of a pustule indicates an inflammatory acne lesion, which is common on the face, including the cheeks.
Other Likely Diagnoses
- Furuncle (Boil): A furuncle is an infection of the hair follicle that can present as a painful, red nodule with a central pustule. The cheek is a possible location, and the duration of 9 months could indicate a chronic or recurrent infection.
- Keratosis Pilaris with Superimposed Infection: While keratosis pilaris itself is not typically painful or associated with pustules, if a lesion becomes infected, it could present similarly to the described condition.
- Perioral Dermatitis: This condition can cause red, inflamed bumps around the mouth, which might extend to the cheeks. While it doesn't typically present with a central pustule, the variability in presentation could make it a consideration.
Do Not Miss Diagnoses
- Basal Cell Carcinoma: Although less likely given the age and description, basal cell carcinoma can sometimes present as a persistent, non-healing lesion that might appear red and inflamed. The presence of a pustule would be unusual but not impossible.
- Squamous Cell Carcinoma: Similar to basal cell carcinoma, squamous cell carcinoma is a skin cancer that could present as a non-healing lesion. It's less common on the cheek but should be considered, especially in sun-exposed areas or in individuals with risk factors.
- Lupus Miliaris Faciei: A rare form of cutaneous lupus that presents as reddish-brown, grouped papules on the face, which could be mistaken for acne or other conditions. It's essential to consider due to its potential for scarring and association with systemic lupus.
Rare Diagnoses
- Granuloma Faciale: A rare, chronic condition characterized by single or multiple, well-demarcated, reddish-brown plaques or nodules on the face. It could potentially present with a pustule, although this is less common.
- Sarcoidosis: While primarily known for its pulmonary manifestations, sarcoidosis can cause skin lesions, including those on the face. These might appear as red, inflamed nodules or plaques, which could be confused with other dermatological conditions.
- Leishmaniasis: In endemic areas, cutaneous leishmaniasis could present as a chronic, non-healing lesion that might resemble a large pustule or ulcer. The cheek is an uncommon location, but it should be considered in travelers to or residents of endemic areas.