Approach to the Problem
Rashes on the face can be an isolated local phenomenon or associated with systemic disease. Clues to the etiology of the rash are found in the anatomic location, distribution, color, type, and the shape of the involved lesions. Many patients and their families are often concerned about the impact of the facial rash on the child’s appearance, self-esteem, and interpersonal interactions.
Key Points in the History
• When acne lesions appear in a child under 7, consider an evaluation for endocrinologic abnormalities.
• In a female with acne and oligomenorrhea or hirsutism, consider evaluation for polycystic ovarian syndrome.
• The lesions of impetigo may be distinguished from contact dermatitis in that impetigo lesions are generally painful, whereas contact dermatitis lesions are pruritic.
• Children with eczema frequently have family members with a history of eczema, allergies, or asthma.
• During winter, when the air has lower humidity, facial rashes exacerbated by dry skin such as eczema, pityriasis alba, and lip-licking dermatitis are often worse.
• Autoimmune diseases can present with a chronic erythematous facial rash. Associated fever and arthritis raise the suspicion for these disorders.
Key Points in the Physical Examination
• Focal rashes on the face are seen with impetigo and tinea corporis.
• Symmetric lesions are seen with infectious processes, such as erythema infectiosum or scarlet fever.
• When evaluating acne, it is important to assess the type of lesions (comedone vs inflammatory), the number and distribution of lesions, and the presence of scarring in order to guide therapy.
• In severe cases of eczema, lesions can be found throughout the body; however, lesions in the axilla or groin area should prompt consideration of other diagnoses, such as psoriasis. If pustules are present, consider superinfection with Staphylococcus aureus.
• Contact dermatitis presents as a localized skin lesion exposed to an irritant, such as nickel-containing clothing snaps or jewelry.
• Vesicular lesions occur in herpes simplex virus (HSV) and coxsackievirus infections. In herpes infections, the vesicles are grouped or dermatomal.
• Rhus dermatitis and some cases of eczema are associated with vesicular lesions.
• Acne presents with comedones.
•
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
