Typical Exam Findings for Facial Dermatitis
Facial dermatitis presents with erythema, edema, xerosis (dry skin), erosions/excoriations, oozing and crusting, and lichenification, with findings varying by patient age and chronicity of lesions. 1
Primary Morphologic Features
Acute Presentation
- Erythematous papulovesicular lesions with excoriation and serous exudate 1
- Edema of affected facial areas 1
- Oozing and crusting, particularly when secondary bacterial infection is present 1
- Vesicles or bullae in some cases 2
- Grouped, punched-out erosions or vesiculation suggesting herpes simplex superinfection 1
Chronic Presentation
- Lichenification from chronic rubbing and scratching 1, 3
- Scaling and increased skin markings 2
- Xerosis (generalized dry skin) as a hallmark feature 1, 3
- Fissures from severe dehydration of the stratum corneum 3
- Papules and excoriations in chronically affected areas 1
Age-Specific Distribution Patterns
Infants and Young Children (Under 4 Years)
- Cheeks and forehead involvement is characteristic 1
- Outer limbs commonly affected 1
- Sparing of groin and axillary regions (helps distinguish from seborrheic dermatitis) 1
Older Children and Adults
- Periorbital involvement with eyelid eczema 1
- Perioral distribution in some cases 1
- Neck involvement with itchiness in skin creases 1
Signs of Complications
Secondary Bacterial Infection
- Crusting or weeping beyond baseline presentation 1, 3
- Honey-colored crusts suggesting Staphylococcus aureus infection 1
- May require bacteriological swabs if not responding to treatment 1
Viral Superinfection
- Grouped, punched-out erosions indicating herpes simplex (eczema herpeticum) 1
- Vesiculation in clustered distribution 1
Severe Exacerbation
- Erythroderma involving >90% of body surface area in extreme cases 4
- Generalized erythematous skin lesions with severe exfoliation 4
Associated Clinical Signs
- Evidence of scratching: excoriations, shortened nails from chronic rubbing 1
- Pruritus as a hallmark feature (though this is a symptom, signs of scratching are visible) 1
- Lymphadenopathy may be present secondary to extensive skin disease 1
- Periorbital darkening (Dennie-Morgan folds) in chronic cases 1
Important Diagnostic Caveats
Contact dermatitis (allergic or irritant) may be indistinguishable from atopic dermatitis on examination alone and should be considered when facial dermatitis has atypical or localized distribution, or when previously stable disease deteriorates. 1, 2 Patch testing is essential when contact allergy cannot be ruled out, particularly with persistent facial eczema. 1
Seborrheic dermatitis overlaps with atopic dermatitis in infancy but typically shows greasy scale in scalp and folds, affects groin/axillary regions, and lacks significant pruritus. 1