Differential Diagnosis

The patient presents with small red bumps around the eyes and nose/nostrils, which have been partially responsive to azelaic acid treatment. Here's a categorized differential diagnosis:

• Single most likely diagnosis
  • Rosacea: The symptoms of small red bumps, burning sensation, and location around the eyes and nose/nostrils are consistent with rosacea, a common skin condition. The partial response to azelaic acid, which is often used to treat rosacea, further supports this diagnosis.
• Other Likely diagnoses
  • Contact dermatitis: The patient's symptoms could be due to an allergic or irritant reaction to a product or substance, such as makeup, skincare, or nasal sprays.
  • Seborrheic dermatitis: This condition can cause red, itchy, and flaky skin around the nose and eyes, and may be exacerbated by stress, cold weather, or other factors.
  • Acne: Although less likely given the location and description, acne could still be a possibility, especially if the patient is experiencing other acne symptoms.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Lupus: Systemic lupus erythematosus (SLE) can cause a butterfly-shaped rash across the nose and cheeks, and may be accompanied by other systemic symptoms.
  • Sarcoidosis: This condition can cause skin lesions, including around the eyes and nose, and may be associated with other systemic symptoms such as fever, fatigue, and joint pain.
• Rare diagnoses
  • Demodex folliculitis: This condition is caused by a mite infestation and can lead to red, itchy bumps around the eyes and nose.
  • Granuloma faciale: A rare skin condition characterized by red, brown, or purple lesions on the face, often around the eyes and nose.