Differential Diagnosis for Discolouration of the Centre of the Forehead and Above the Eyebrows

• Single most likely diagnosis
  • Contact dermatitis: This is a common condition that can cause discoloration and skin irritation due to an allergic reaction or sensitivity to substances like makeup, hair products, or certain metals found in jewelry. The central forehead and area above the eyebrows are common sites for such reactions due to the frequent use of these products in these areas.
• Other Likely diagnoses
  • Seborrheic dermatitis: Characterized by a red, itchy, and flaky rash, seborrheic dermatitis often affects oily areas of the body, such as the face, including the forehead and the area above the eyebrows.
  • Eczema (atopic dermatitis): Eczema can cause patches of dry, itchy skin that may become discolored. It can appear anywhere on the body, including the forehead.
  • Psoriasis: Although less common on the face, psoriasis can cause red, scaly patches that may lead to discoloration.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Malignant melanoma or other skin cancers: Although rare, any new or changing skin lesion, especially those that are pigmented, should be evaluated for the possibility of skin cancer.
  • Lupus: Systemic lupus erythematosus can cause a butterfly-shaped rash across the cheeks and nose but may also involve the forehead. It's a serious autoimmune disease that requires prompt diagnosis and treatment.
• Rare diagnoses
  • Sarcoidosis: A condition that can cause skin lesions, including on the face, and may lead to discoloration. It's characterized by the growth of granulomas (inflammatory cells) in different parts of the body.
  • Erythema migrans (Lyme disease): Typically presents as a circular expanding rash, but in rare cases, it might appear on the forehead or above the eyebrows, especially if the tick bite occurred in those areas.