Differential Diagnosis for a 77-year-old Female with a Rash on the Face at Night, Exacerbated by Wine
- Single most likely diagnosis:
- Rosacea: This condition is characterized by a rash on the face, often exacerbated by factors such as alcohol consumption (including wine), and can be more noticeable at night due to increased blood flow. The patient's age and the specific triggers mentioned align with rosacea.
- Other Likely diagnoses:
- Contact Dermatitis: An allergic reaction or irritation from products used on the face could cause a rash, potentially worsened by alcohol consumption if it affects the skin's barrier function.
- Atopic Dermatitis (Eczema): Although more common in younger individuals, atopic dermatitis can persist into older age and may be exacerbated by alcohol, leading to facial rashes.
- Seborrheic Dermatitis: This condition causes a rash, often on the face, and can be influenced by various factors, including alcohol use.
- 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 on the face, which might be exacerbated by alcohol and could be more noticeable at night. Although less common, missing lupus could have severe consequences.
- Malignancy (e.g., Cutaneous T-cell Lymphoma): Certain skin cancers can present with rashes and might be exacerbated by alcohol. Early detection is crucial for treatment.
- Rare diagnoses:
- Brachioradial Pruritus: Although this condition primarily affects the arms, it can sometimes involve the face and is characterized by intense itching, often worse at night. Alcohol might exacerbate the symptoms.
- Erythromelalgia: A disorder that causes burning pain, heat, and redness in the hands and feet, but can occasionally affect the face. It might be worsened by alcohol and could be more noticeable at night due to increased blood flow.