Differential Diagnosis for Vesicles on Eyelid and Lip

• Single most likely diagnosis
  • Herpes Simplex Virus (HSV) infection: This is the most common cause of vesicular lesions on the eyelid and lip, often presenting as cold sores or herpes labialis. The presence of vesicles in these areas, especially if recurrent, strongly suggests HSV.
• Other Likely diagnoses
  • Herpes Zoster (Shingles): Although less common than HSV for lip lesions, herpes zoster can cause vesicles on the eyelid, particularly if it involves the ophthalmic division of the trigeminal nerve (zoster ophthalmicus).
  • Impetigo: A bacterial infection that can cause vesicles or pustules on the face, including the eyelids and lips, though it's more commonly seen in children.
  • Eczema (Atopic Dermatitis): Can sometimes present with vesicular lesions, especially in acute phases or with specific types like dyshidrotic eczema, though it's less common on the eyelids.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
  • Varicella-Zoster Virus (Chickenpox): Though rare in adults, especially those vaccinated, it can present with vesicles all over the body, including the face. Missing this diagnosis could lead to serious complications, especially in immunocompromised individuals.
  • Stevens-Johnson Syndrome (SJS) or Toxic Epidermal Necrolysis (TEN): These are severe skin conditions usually triggered by medications or infections, characterized by widespread skin necrosis and detachment. Early recognition is crucial as these conditions have high mortality rates.
• Rare diagnoses
  • Pemphigus Vulgaris: An autoimmune disease that can cause blistering of the skin and mucous membranes, including the eyelids and lips, though it's relatively rare.
  • Bullous Pemphigoid: Another autoimmune blistering disease that can affect the skin and, less commonly, the mucous membranes, including those around the eyes and mouth.