Differential Diagnosis for Bilateral Cheek and Periorbital Edema

Given the presentation of mild bilateral edema on the cheeks and periorbital area, the differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis
  • Allergic Reaction: This is often the first consideration due to its common occurrence and the potential for facial edema as a manifestation. Allergic reactions can range from mild to severe (anaphylaxis) and can be caused by a variety of substances including foods, medications, and environmental allergens.
• Other Likely Diagnoses
  • Angioedema: Similar to allergic reactions, angioedema involves deeper layers of the skin and can cause significant swelling, often without the typical signs of allergy like urticaria. It can be hereditary or acquired.
  • Insect Bites or Stings: Reactions to insect bites or stings can cause localized or, in some cases, more generalized edema, including facial swelling.
  • Contact Dermatitis: An allergic or irritant reaction to substances coming into contact with the skin can cause edema, redness, and itching.
• Do Not Miss Diagnoses
  • Nephrotic Syndrome: While less common, nephrotic syndrome can cause significant edema due to hypoalbuminemia. Facial edema can be a presenting feature, and missing this diagnosis could lead to delayed treatment of underlying renal disease.
  • Thyroid Eye Disease: Part of Graves' disease, thyroid eye disease can cause periorbital edema, among other symptoms like exophthalmos and eyelid retraction.
  • Superior Vena Cava Syndrome: Obstruction of the superior vena cava can lead to facial edema, particularly in the periorbital area, and is a medical emergency.
• Rare Diagnoses
  • Sarcoidosis: A systemic granulomatous disease that can cause uveitis, skin lesions, and lymphadenopathy, and in rare cases, facial edema.
  • Melkersson-Rosenthal Syndrome: A rare neurological disorder characterized by recurrent, often unilateral, facial paralysis or weakness, swelling of the face and lips (usually the upper lip), and the development of folds and furrows in the tongue (fissured tongue).
  • Erythema Multiforme: An acute, self-limiting, mucocutaneous hypersensitivity reaction most commonly triggered by infections and certain medications, which can rarely present with facial edema.

Each of these diagnoses has distinct features and potential causes, and a thorough history, physical examination, and sometimes additional diagnostic tests are necessary to determine the underlying cause of the bilateral cheek and periorbital edema.