Differential Diagnosis for Papulopular Itchy Lesions on the Face
Single Most Likely Diagnosis
- Atopic Dermatitis (Eczema): This is a common condition characterized by itchy, inflamed skin that can appear anywhere on the body, including the face. The facial involvement, especially in adults, can be part of a broader atopic syndrome or an isolated finding.
Other Likely Diagnoses
- Contact Dermatitis: This condition occurs when the skin comes into contact with an irritant or allergen, leading to an itchy, red rash. Common culprits include cosmetics, soaps, and metals like nickel.
- Seborrheic Dermatitis: Characterized by a red, itchy, and flaky rash, typically on the scalp, but can also affect oily areas of the body like the face. It's more common in areas rich with sebaceous glands.
- Rosacea: A chronic skin condition that causes redness, pimples, and, in some cases, thickened skin on the face. While not always itchy, some patients may experience itching or burning sensations.
- Demodex Folliculitis: Caused by the Demodex mite, which can lead to itchy, inflamed follicles, particularly on the face.
Do Not Miss Diagnoses
- Lupus Erythematosus: A systemic autoimmune disease that can cause a variety of skin manifestations, including a butterfly-shaped rash across the cheeks and nose. It's crucial to consider due to its potential for serious systemic complications.
- Sarcoidosis: An autoimmune disease that can affect multiple parts of the body, including the skin, lungs, and eyes. Skin manifestations can include papules, plaques, and nodules, which may be itchy.
- Cutaneous T-Cell Lymphoma (Mycosis Fungoides): A rare type of skin cancer that can initially present with itchy, eczematous patches or plaques, which may resemble more benign conditions.
Rare Diagnoses
- Pityriasis Rubra Pilaris: A rare skin disorder characterized by salmon-colored scaling patches and can involve the face, though it's more commonly associated with the body.
- Keratosis Pilaris: A condition that causes rough patches and small, acne-like bumps on the skin, often on the arms, legs, buttocks, and cheeks. It can sometimes be itchy.
- Granuloma Faciale: A rare, chronic skin condition characterized by single or multiple, reddish-brown, well-demarcated plaques or nodules, typically on the face, which can be itchy.