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Differential Diagnosis for Rash that Itches on the Chest and Face and Worsens in the Sun

Single Most Likely Diagnosis

  • Polymorphic Light Eruption (PMLE): This is the most common photodermatosis, characterized by an itchy rash that appears on sun-exposed areas, typically within hours to days after sun exposure. The rash often appears on the chest and face, fitting the described symptoms.

Other Likely Diagnoses

  • Atopic Dermatitis (Eczema): While not exclusively triggered by sun exposure, atopic dermatitis can worsen with UV radiation in some individuals. It's known for causing itchy skin and can affect the face and chest.
  • Seborrheic Dermatitis: This condition causes scaly patches, red skin, and stubborn dandruff, often on oily areas of the body like the face. It can be exacerbated by sun exposure and may cause itching.
  • Contact Dermatitis: An allergic reaction or irritation from substances like sunscreen, fragrances, or certain metals can cause a rash that itches, especially if these substances are applied to the face and chest before sun exposure.

Do Not Miss Diagnoses

  • Lupus Erythematosus: Systemic lupus erythematosus (SLE) can cause a photosensitive rash, often on the face (butterfly rash) and chest. Missing this diagnosis could lead to significant morbidity due to the systemic nature of the disease.
  • Porphyria Cutanea Tarda: A disorder that leads to blistering of the skin upon sun exposure, which can be very painful and disfiguring. Early diagnosis is crucial for management.
  • Cutaneous T-Cell Lymphoma (Mycosis Fungoides): Although rare, this condition can present with skin lesions that are worsened by sun exposure. It's critical to diagnose early due to its potential progression.

Rare Diagnoses

  • Solar Urticaria: A rare condition where exposure to UV or visible light induces urticaria (hives). It's an important diagnosis to consider in patients with urticaria that seems to be triggered by sun exposure.
  • Chronic Actinic Dermatitis: A rare skin condition characterized by a persistent, itchy, eczematous eruption in sun-exposed areas, typically seen in older males.
  • Xeroderma Pigmentosum: A genetic disorder where the body is unable to repair DNA damage caused by UV light, leading to severe sun sensitivity, skin lesions, and a high risk of skin cancers. It's extremely rare but critical to diagnose early.

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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