| What are common causes of red face? | • Seborrheic dermatitis
• Eczema
• Rosacea
• Lupus
• and others |
| How does seborrheic dermatitis cause red face? | • Seborrheic dermatitis is a very common inflammatory reaction to the Malassezia (Pityrosporum ovale) yeast that thrives on seborrheic (oil- producing) skin
• It presents as erythematous scaling patches on the scalp, hairline, eyebrows, eyelids, central face and nasolabial folds, or external auditory canals
• In patients with darker skin it can be hypopigmented rather than erythematous
• It can also affect the central chest and axillary folds
• Seborrheic dermatitis is more common and severe in patients with HIV or neurologic disease (e.g. Parkinson’s disease or stroke) |
| How does Rosacea causing red face? | • Rosacea is typically located on the mid face including the nose and cheeks with occasional involvement of the brow, chin, eyelids, and eyes Patients have variable amounts of erythema, telangiectasias, papules and/or pustules
• Rosacea does not have comedones – this helps to distinguish rosacea from acne vulgaris
• Some patients may develop rhinophyma (overgrowth of the dermis and sebaceous glands)
• Patients can have ocular rosacea: keratitis, blepharitis, conjunctivitis Artificial tears, oral doxycycline and cyclosporine eyedrops can be effective therapies |
| What is Rosacea demodex? | • Part of commensal flora
• Retrospective review of ~50 published studies
• Significant correlation between :
- Demodex infestation and rosacea
- Amount of demodex on the skin is important
• In vivo confocal microscopy
• 25 adult rosacea patients and 25 matched controls
• Rosacea patients: 165 mites per 8mm²
• Control patients: 35 mites per 8mm²(p<0.0001) |
| How is perioral dermatitis? | • Presents as perioral erythemaand papules sparing the area near the vermilion border
• Idiopathic or iatrogenic due to use of topical steroids
• Need to wean off steroids, decrease inflammation
• Treatment: Doxycycline, minocycline, or erythromycin x 1-3 months
• Topical antibiotics: metronidazole, clindamycin
• Pimecrolimus cream or tacrolimus ointment BID for 2-3 months |
| What is malar rash? | Lupus,
• Many facial rashes are described as “malar” or “butterfly” rashes
• Most “butterfly” rashes are seborrheic dermatitis or rosacea, not lupus, which is classically described as “malar” or “butterfly”
Four SLE criteria are dermatologic:
• Photosensitivity
• Discoid lesions
• Oral ulcerations
• Malar rash |
| How does atopic dermatitis cause red face? | • Eczema Patients may have the “atopic triad” includes
seasonal allergic rhinitis, asthma, and atopic dermatitis
• Patients have a higher rate of eyelid and hand eczema
• Itch is the primary symptom of eczema
• A potassium hydoxide mount can distinguish from
tinea facei
• Distribution of eczema varies by type of eczema See
Red Scaling Rashes for more information |
| How is management of eczema? | • Topical corticosteroids are the first-line treatment for
eczema, even for the face Topical calcineurin inhibitors
are effective for long-term maintenance for patients
that flare after short-term (2-3 weeks) steroid therapy
treatment
• Emollients (moisturizers) are helpful for soothing dry,
itchy, or irritated skin
• Patch testing can be used if an allergic contact
dermatitis is suspected or if the eczema is recalcitrant |
| How does allergic contact dermatiits cause red face? | • Allergic contact dermatitis (ACD) is a delayed-type
hypersensitivity reaction Poison ivy (rhus dermatitis) is
the prototypic allergic contact dermatitis
• Patients become sensitized to an allergen in contact
with their skin
• ACD is pruritic or burning/irritated
• The distribution of the rash mirrors the area of
exposure |
| How does eyelid dermatitis? | • Etiologies: Atopic dermatitis, ACD, dermatomyositis, seborrhea
• Dermatomyositis is an autoimmune disease
Patients often have a violaceus rash of eyelids and “shawl” rash on the upper chest, shoulders, and back
• Skin biopsy and blood work can establish the
diagnosis |
