Clinical Red Face

The Red Face

Dr Sami Aldaham

• YEASTS - Seborrheic dermatitis
• Rosacea - SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)
• Atopic Dermatitis
• Allergic Contact Dermatitis (ACD)
• Acne vulgaris

Summary of the red face: likely causes by age

Red rashes on the face are common throughout life, but the causes differ by age

1. In infants, atopic dermatitis is more likely
2. In adolescents, acne vulgaris is very common
3. Acne rosacea presents in the 30s-40s
4. Seborrheic dermatitis occurs at any age

Summary of the red face: clues in the history

• Itch precedes onset: Allergic contact dermatitis, Atopic dermatitis
• Greasy scale and redness: Seborrheic dermatitis
• Tender papules: Acne vulgaris, Rosacea
• Worse with exercise, heat, hot foods, alcohol: Rosacea

Summary of the red face: clues by location

• Eyebrows, nasal creases, external auditory canals
  • Seborrheic dermatitis
• Cheeks and chin:
  • Acne vulgaris, acne rosacea, atopic dermatitis
• Nose
  • Involved in acne vulgaris, acne rosacea
  • Spared in atopic dermatitis

Location

• Seborrheic dermatitis

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• Acne rosacea

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• Atopic dermatitis (infants)

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• Acne vulgaris

Take Home Points

• Location, history, and age help differentiate red rashes on the face

• Seborrheic dermatitis is common and chronic

  • Ask about and inspect key locations: external auditory canals, eyebrows, scalp, behind ears, central chest
  • Treatment with ketoconazole cream or dandruff shampoos or low-potency steroid like desonide cream for flares

• Heat, exercise, hot liquids, spicy foods, and alcohol, are triggers for acne rosacea

• Atopic dermatitis in infants often involves the face

• Allergic contact dermatitis itches and mirrors the source of exposure

• Acne vulgaris typically arises in puberty; see acne module for detailed management recommendations

• Butterfly rash of connective tissue disease is most frequently seen in flares of SLE and often has other manifestations of lupus at that time