Differential Diagnosis for Pustules in the Perioral Area
- Single most likely diagnosis
- Acne vulgaris: This is the most common condition associated with pustules in the perioral area, especially during puberty but can occur at any age. It is characterized by comedones, papules, pustules, and sometimes cysts due to blockage of the pilosebaceous units and bacterial overgrowth.
- Other Likely diagnoses
- Perioral dermatitis: A condition that presents with small papules and pustules around the mouth, often due to the use of topical corticosteroids, cosmetics, or other irritants. It can be distinguished from acne by its characteristic distribution around the mouth and the absence of comedones.
- Folliculitis: An inflammatory condition of the hair follicles, which can present with pustules, especially if caused by bacterial infection (such as Staphylococcus aureus). It can occur in the perioral area, especially if there is a history of shaving or other forms of follicular irritation.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Herpes simplex virus (HSV) infection: Although typically presenting with vesicles rather than pustules, HSV can cause significant morbidity if not recognized and treated promptly, especially in immunocompromised patients. The presence of grouped vesicles or pustules in the perioral area should raise suspicion for HSV.
- Impetigo: A contagious bacterial infection (caused by Staphylococcus aureus or Streptococcus pyogenes) that can present with pustules or honey-colored crusts. It is essential to diagnose and treat to prevent spread and potential complications like post-streptococcal glomerulonephritis.
- Rare diagnoses
- Sarcoidosis: A systemic granulomatous disease that can rarely present with skin manifestations, including pustules in the perioral area, as part of its cutaneous involvement.
- Granulomatous perioral dermatitis: A rare variant of perioral dermatitis characterized by granulomatous inflammation, which can present with pustules and papules around the mouth. It is distinguished by its histopathological findings and can be challenging to treat.