Differential Diagnosis for Small Erythematous Papules on Forehead and Cheek
Single Most Likely Diagnosis
- Folliculitis: This is the most likely diagnosis given the patient's history of using tweezers to pull out hair, which can cause irritation and infection of the hair follicles, leading to small erythematous papules. The localized nature of the lesions to one side of the face, where the tweezers were used, further supports this diagnosis.
Other Likely Diagnoses
- Keratosis Pilaris: This condition causes small, rough, erythematous papules, often on the cheeks and forehead, and can be exacerbated by dry skin or other forms of skin irritation, including the use of tweezers.
- Acne: Given the location on the face, acne (including comedonal, inflammatory, or excoriative forms) could be a consideration, especially if the patient has a history of acne or if the lesions are predominantly on areas prone to acne.
- Contact Dermatitis: An allergic or irritant reaction to a product used on the face (e.g., makeup, skincare products) could cause erythematous papules, especially if the reaction is localized to the area where the product is applied.
Do Not Miss Diagnoses
- Lupus Miliaris Faciei: Although less common, this condition can present with small, reddish-brown papules on the face and can be mistaken for other dermatoses. It's crucial to consider this diagnosis due to its potential for scarring and the need for specific treatment.
- Sarcoidosis: Cutaneous sarcoidosis can manifest as erythematous papules among other skin lesions. Given its systemic implications, missing this diagnosis could have significant consequences.
- Tuberculosis (Cutaneous): Rarely, cutaneous tuberculosis can present with papular lesions on the face. Given the potential severity of untreated tuberculosis, it's essential to consider this in the differential diagnosis.
Rare Diagnoses
- Demodex Folliculitis: Caused by the Demodex mite, this condition can lead to follicular-based erythematous papules, particularly in the facial area. It's less common but should be considered in cases where other diagnoses are ruled out.
- Erythema Elevatum Diutinum: A rare form of leukocytoclastic vasculitis that can present with erythematous papules, plaques, or nodules, typically on the extensor surfaces but can occasionally be seen on the face.
- Granuloma Faciale: A rare, chronic condition characterized by single or multiple, well-demarcated, erythematous to violaceous plaques or papules, usually on the face. It's essential to consider this in the differential for facial lesions that do not respond to typical treatments.