Differential Diagnosis for Erythema and Papules on the Face
Single most likely diagnosis
- Rosacea: This condition is characterized by recurrent episodes of erythema, papules, and pustules, typically on the central face, including the nasal and chin areas. The age of the patient and the description of the symptoms make rosacea a strong candidate.
Other Likely diagnoses
- Acne: Although less common in older adults, acne can still occur and may present with erythema and papules. The location around the nasals and chin is consistent with acne.
- Seborrheic dermatitis: This condition can cause erythema and papules, particularly in areas rich in sebaceous glands like the face. Itchiness can also be a feature, although it's not always present.
- Contact dermatitis: Allergic or irritant contact dermatitis could explain the erythema, papules, and itchiness, especially if the patient has recently introduced new skincare products or has been exposed to allergens or irritants.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Lupus erythematosus: Although less likely, systemic lupus erythematosus (SLE) can present with a malar rash (butterfly-shaped rash across the cheeks) and may involve the nasal and chin areas. Missing this diagnosis could have significant consequences due to the potential for systemic involvement.
- Sarcoidosis: This condition can cause skin lesions, including erythema and papules, and can be associated with systemic symptoms. It's crucial not to miss sarcoidosis due to its potential to affect multiple organ systems.
Rare diagnoses
- Demodex folliculitis: Caused by the Demodex mite, this condition can lead to erythema, papules, and pustules, particularly on the face. It's less common but should be considered in cases that don't respond to typical treatments.
- Granulomatous rosacea (Lupus pernio): A rare variant of rosacea characterized by granulomatous lesions, which could present similarly to the described symptoms.