Differential Diagnosis for a 25F with Intermittent Erythematous Plaque

• Single Most Likely Diagnosis
  • Acne: Given the location (chin, around lips, and sometimes around the nose) and description (erythematous plaque with bumps), acne is a highly probable diagnosis. The presence of bumps and the specific areas affected are common characteristics of acne, particularly acne vulgaris.
• Other Likely Diagnoses
  • Perioral Dermatitis: This condition presents with erythematous papules and pustules around the mouth, which could fit the description provided. It's often seen in young women and can be triggered by various factors, including cosmetics and stress.
  • Seborrheic Dermatitis: Although it more commonly affects the scalp, seborrheic dermatitis can also occur on the face, including around the nose and mouth, presenting with erythematous, scaly plaques.
  • Rosacea: Characterized by episodes of flushing, erythema, small and superficial dilated blood vessels on facial skin, and often accompanied by acne-like lesions, rosacea could be considered given the facial distribution and the presence of erythema and bumps.
• Do Not Miss Diagnoses
  • Lupus: Systemic lupus erythematosus (SLE) can present with a malar rash (butterfly-shaped rash across the cheeks) and may involve the chin and nose. Although less likely, missing SLE could have significant consequences due to its systemic nature and potential for serious complications.
  • Sarcoidosis: This condition can cause skin lesions, including erythematous plaques, and can affect the face. It's crucial not to miss sarcoidosis due to its potential for systemic involvement, including the lungs and other organs.
• Rare Diagnoses
  • Demodex Folliculitis: Caused by the Demodex mite, this condition can lead to follicular-based eruptions, particularly on the face. It's less common but could be considered in cases that are resistant to typical acne treatments.
  • Granulomatous Rosacea (Lupus Perio): A rare variant of rosacea characterized by granulomatous lesions, often around the mouth. It's an important consideration due to its distinct treatment approach and potential for disfigurement if left untreated.