Differential Diagnosis for Facial Lesions

When attempting to differentiate between heavy scabbing from abrasions and impetigo on the face versus chemical burns less than 24 hours old, it's crucial to consider various diagnoses based on their likelihood and potential impact. The following categorization helps in systematically approaching the differential diagnosis:

• Single Most Likely Diagnosis
  • Impetigo: This is a highly contagious bacterial skin infection that often presents with scabbing, especially on the face. It's common in children but can occur in adults as well. The presence of golden-yellow crusts is a hallmark, which could be mistaken for scabbing from abrasions or early stages of chemical burns.
• Other Likely Diagnoses
  • Abrasions: These are superficial wounds caused by scraping or rubbing the skin against a rough surface. They can present with scabbing as part of the healing process and are very common, especially on the face.
  • Chemical Burns: Although less common than impetigo or abrasions, chemical burns can occur from exposure to caustic substances. The appearance can vary widely depending on the substance and concentration, but early stages might resemble scabbing or abrasions.
• Do Not Miss Diagnoses
  • Erythema Multiforme: A skin condition characterized by target lesions, which can sometimes be confused with burns or severe skin reactions. It's crucial to identify because it can be associated with systemic diseases or drug reactions.
  • Stevens-Johnson Syndrome (SJS) / Toxic Epidermal Necrolysis (TEN): These are severe skin and mucous membrane disorders, usually a reaction to medication or infection. Early recognition is critical due to their high morbidity and mortality rates.
• Rare Diagnoses
  • Staphylococcal Scalded Skin Syndrome (SSSS): A condition caused by staphylococcal toxins that typically affects infants and young children, characterized by tender erythematous skin that progresses to bullae and then peels, resembling burns.
  • Pemphigus Vulgaris: An autoimmune disease that causes blistering of the skin and mucous membranes. It's rare but can be life-threatening if not treated properly.

Each of these diagnoses requires careful consideration of the patient's history, physical examination, and sometimes additional diagnostic tests to accurately differentiate between them. The key to diagnosis lies in a meticulous clinical assessment and, when necessary, laboratory confirmation.