Differential Diagnosis of Periorbital Rash

When considering a periorbital rash, it's crucial to approach the diagnosis systematically to ensure that all potential causes are considered. The differential diagnosis can be organized into several categories based on the likelihood and severity of the conditions.

• Single Most Likely Diagnosis

  • Atopic Dermatitis (Eczema): This is often the most common cause of periorbital rashes, especially in individuals with a history of atopy. The rash is typically itchy, red, and may be accompanied by scaling.

• Other Likely Diagnoses

  • Contact Dermatitis: This can occur due to allergic reactions or irritants such as makeup, makeup removers, or certain chemicals in skin care products. The rash is usually confined to the area of contact.
  • Seborrheic Dermatitis: Characterized by a red, itchy, and flaky rash, it often affects the oily areas of the body, including the face and around the eyes.
  • Rosacea: Although it primarily affects the central face, rosacea can sometimes cause periorbital symptoms, including redness and papules.
  • Blepharitis: Inflammation of the eyelids can cause a rash, redness, and itching around the eyes, often associated with crusting and discomfort.

• Do Not Miss Diagnoses

  • Herpes Zoster (Shingles): When it affects the trigeminal nerve, particularly the ophthalmic branch, it can cause a painful rash around the eye, potentially leading to serious complications like blindness if not promptly treated.
  • Cellulitis: A bacterial infection of the skin and subcutaneous tissues that can cause redness, swelling, and warmth around the eye. It requires immediate antibiotic treatment to prevent serious complications.
  • Angioedema: Although it typically presents with deeper tissue swelling, it can sometimes cause a rash and is a medical emergency, especially if it involves the airway.

• Rare Diagnoses

  • Sarcoidosis: A systemic disease that can cause skin manifestations, including rashes around the eyes, though this is less common.
  • Lupus: Systemic lupus erythematosus can cause a variety of skin rashes, including those around the eyes, but this is part of a broader spectrum of systemic symptoms.
  • Dermatomyositis: An autoimmune condition that can cause a characteristic heliotrope rash around the eyes, among other symptoms like muscle weakness.

Each of these diagnoses has distinct features and implications for treatment, emphasizing the importance of a thorough clinical evaluation to determine the underlying cause of a periorbital rash.