Differential Diagnosis for 8-year-old Female with Rash Spreading from Neck to Chin to Right Eyelid

• Single most likely diagnosis:
  • Eczema (Atopic Dermatitis): This is a common condition in children, characterized by itchy, inflamed skin that can spread across different parts of the body, including the face and neck. The pattern of spread from the neck to the chin and then to the eyelid could be consistent with eczema, especially if the child has a history of atopic diseases like asthma or allergies.
• Other Likely diagnoses:
  • Contact Dermatitis: This condition occurs when the skin comes into contact with an irritant or allergen, leading to a rash. Given the location of the rash, it's possible that the child came into contact with something that irritated her skin, starting from the neck and spreading to the chin and eyelid.
  • Impetigo: A contagious bacterial skin infection that can cause red sores on the face, which can spread to other areas. It often starts around the nose and mouth but can spread to other parts of the face, including the eyelids.
  • Allergic Reaction: An allergic reaction to food, medication, or an environmental factor could cause a rash that spreads across the body. The face and neck are common areas for allergic reactions to manifest.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Meningitis: Although rare, meningitis can cause a rash (especially in the case of meningococcal meningitis), and it's crucial to consider this diagnosis, especially if the child has other symptoms like fever, headache, or stiff neck.
  • Lyme Disease: If the child has been exposed to ticks, Lyme disease could be a consideration, as it can cause a rash (erythema migrans) that spreads from the site of the tick bite.
• Rare diagnoses:
  • Kawasaki Disease: A rare condition that mainly affects children under the age of 5 but can occur in older children. It causes inflammation in the walls of medium-sized arteries throughout the body and can lead to a rash, among other symptoms.
  • Stevens-Johnson Syndrome: A rare but serious disorder of the skin and mucous membranes, usually caused by an adverse reaction to medication or infection. It can cause a rash that spreads across the body, including the face, and is considered a medical emergency.