Differential Diagnosis for Dryness and Itchiness of Outer Aspect Lower Eyelid in a 7-Year-Old

• Single Most Likely Diagnosis
  • Atopic Dermatitis (Eczema): This condition is common in children and often presents with dryness and itchiness, particularly on the face, including the eyelids. The age of the patient and the symptoms described make atopic dermatitis a highly plausible diagnosis.
• Other Likely Diagnoses
  • Allergic Contact Dermatitis: This could be due to an allergic reaction to substances like makeup, makeup removers, or certain ingredients in eye drops or creams. Given the location on the outer aspect of the lower eyelid, exposure to allergens is possible.
  • Blepharitis: An inflammation of the eyelids that can cause itchiness and dryness. It's common and can be associated with other conditions like rosacea or seborrheic dermatitis.
  • Dry Eye Syndrome: Although more common in adults, children can also experience dry eye, especially if they have underlying conditions like blepharitis or use digital devices extensively.
• Do Not Miss Diagnoses
  • Basal Cell Carcinoma or Other Skin Cancers: Although extremely rare in children, any persistent lesion or area of concern on the eyelid should be evaluated for malignancy to ensure early detection and treatment.
  • Infections (Bacterial, Viral, or Fungal): Certain infections can cause symptoms similar to those described and require prompt treatment to prevent serious complications.
• Rare Diagnoses
  • Keratoconjugunctivitis Sicca (Dry Eye Syndrome due to reduced tear production): This is less common in children but can be associated with autoimmune disorders.
  • Phthiriasis Palpebrarum (Eyelid Infestation by Lice): A rare condition that can cause intense itching and should be considered in the differential diagnosis, especially if other treatments fail.