Differential Diagnosis for a 55-year-old Lady with Chronic Vesicular Lesions on the Right Upper and Lower Eyelids
- Single most likely diagnosis
- Blepharitis: This condition is characterized by inflammation of the eyelids, which can cause vesicular lesions, itchiness, and intermittent symptoms. The chronic nature of the symptoms and the location on the eyelids make blepharitis a strong candidate.
- Other Likely diagnoses
- Atopic dermatitis (eczema): This condition can cause itchy, vesicular lesions on the eyelids, especially in individuals with a history of atopy. The intermittent nature of the symptoms could be related to exposure to allergens or irritants.
- Contact dermatitis: Similar to atopic dermatitis, contact dermatitis can cause itchy, vesicular lesions on the eyelids due to exposure to allergens or irritants, such as makeup, soap, or other products.
- Seborrheic dermatitis: This condition can cause a red, itchy, and flaky rash on the eyelids, which could be mistaken for vesicular lesions.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Basal cell carcinoma: Although less likely, basal cell carcinoma can present as a chronic lesion on the eyelid, and it's essential to rule out this diagnosis due to its potential for malignancy.
- Squamous cell carcinoma: Similar to basal cell carcinoma, squamous cell carcinoma can present as a chronic lesion on the eyelid and requires prompt attention due to its potential for malignancy.
- Rare diagnoses
- Angioedema: This condition can cause sudden, severe swelling of the eyelids, which could be mistaken for vesicular lesions. However, angioedema is typically more acute and severe than the symptoms described.
- Herpes zoster (shingles): Although rare, herpes zoster can cause a vesicular rash on the eyelids, especially in older adults. This diagnosis is essential to consider due to the potential for serious complications, such as vision loss.