Differential Diagnosis for Intermittent Facial Rash
- Single most likely diagnosis:
- Seborrheic Dermatitis: This condition is characterized by a rash that can appear on the face, particularly in areas rich with sebaceous glands, such as the nose and forehead. It often presents with small bumps and can be exacerbated by dry skin, which fits the description of the rash drying out after washing and improving with lotion application. The intermittent nature and the fact that it started during the winter, a time when skin tends to be drier, also support this diagnosis.
- Other Likely diagnoses:
- Atopic Dermatitis (Eczema): Given the description of small bumps, some of which are sore, and the relief provided by lotion, atopic dermatitis is a plausible diagnosis. It's common for atopic dermatitis to flare in dry environments, such as during the winter.
- Rosacea: This condition can cause facial redness and small bumps, often exacerbated by environmental factors, though none were identified in this case. The fact that the presentation is less red than usual today could still fit within the variability of rosacea symptoms.
- Contact Dermatitis: This is a possibility if the patient has recently started using a new skincare product or lotion that could be irritating the skin, though the fact that lotion provides some relief makes this less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Lupus: Systemic lupus erythematosus can cause a butterfly-shaped rash across the cheeks and nose, which might be intermittent. Although less likely, missing lupus could have significant consequences due to its potential to affect multiple organ systems.
- Sarcoidosis: This condition can cause skin lesions, among other symptoms, and while rare, it's a diagnosis that should not be missed due to its potential systemic implications.
- Rare diagnoses:
- Demodex Folliculitis: Caused by a mite that lives in hair follicles, this condition can lead to a facial rash and could be considered if other diagnoses are ruled out.
- Granulomatous Rosacea: A variant of rosacea that can cause more severe symptoms, including granulomatous lesions on the face. It's less common but could be a consideration in persistent or severe cases.