Facial dermatitis is a common and frequent disease in dermatology. There is no difficulty in diagnosing facial dermatitis alone, but it is not easy to analyze its causes in detail. Facial dermatitis, especially cosmetic dermatitis, is mostly not taken seriously by patients. Although contact dermatitis is the most common, sometimes other causes of dermatitis are not easily distinguished clinically from facial contact dermatitis. Therefore, careful analysis of the pathogenesis and its symptomatic features, combined with the patch test will help the clinical differential diagnosis.
1. Facial contact dermatitis.
Cosmetics, topical medications, occupational exposures and certain household products can cause facial allergic contact dermatitis, such as hair dye allergy, which often causes dermatitis on both upper lids, hairline edges and both earlobes, eyeglass frames often cause dermatitis in the temporal and infraorbital areas, cosmetics often cause dermatitis in both cheeks, and topical medications can often cause dermatitis at the place where they are used.
Industrial dust and other airborne substances can cause airborne contact dermatitis on the face and neck. Cosmetics and other direct use of plant juices for cosmetic purposes can also directly cause irritant contact dermatitis. Plant juices such as cucumber juice, watermelon juice, and allergens such as pollen can cause delayed contact reactions. Some substances such as shampoos and rubber creams can also promote luminous allergic dermatitis, etc. Careful history taking, skin examination and patch testing are the keys to diagnosis. A high degree of vigilance should be maintained and the diagnosis should not be made lightly.
Due to the nature of the exposure, the mode of exposure and individual reactivity, the form, extent and severity of the dermatitis varies. In mild cases, there is light redness or erythema with slight edema or dense pinpoint papules. In severe cases, the erythema is swollen and obvious, and there are dense papules, blisters, and also blisters can occur.
2. Seasonal contact dermatitis.
It is a seasonal recurring, contact dermatitis caused by pollen, which occurs in spring and autumn and is more frequent in women. There are reports of patients with increased levels of IGE and positive pollen patch. Clinical manifestations are mild erythema and edema on the face and neck, mixed with red edematous papules of half a meter in size, with furfuraceous scales at a later stage. It may be mixed with pruritus, recurring every year, and may subside on its own.
However, it should be noted that in the spring, many children and women due to dry air, windy facial dehydration resulting in reduced skin protection, washing too often, dry environment, wind blowing and other factors caused by the face, especially the cheek mild erythema, with fine scales, heavy can have small cracks, mixed with mild pain. This disease should be distinguished from seasonal contact dermatitis, which is recommended to be called seasonal facial dermatitis.
3. Seborrheic dermatitis.
Mostly on the basis of seborrhea, often starting from the head and gradually spreading downward, preferably in areas with more sebaceous gland distribution. Such as the arch of the eyebrows, nasolabial folds, jaw, behind the ears, etc.. The typical damage is a yellow-red patch with greasy scales, with clear boundaries, mixed with itching.
4. Facial reoccurring dermatitis.
The onset of the disease is mostly related to dust, pollen, cosmetics, sunlight stimulation, mental stress, fatigue and digestive dysfunction. Most often seen in women aged 20 to 40, mainly in spring and autumn, with sudden onset and self-induced itching. The lesions begin around the eyelids and gradually extend to the face. The lesions are mostly mild limited erythema, and mild swelling, with rice bran-like fine scales, but no blistering, papules, and infiltration and mossiness.
5. Facial hormone-dependent dermatitis.
Also known as steroidal dermatitis or steroidal rosacea, it refers to persistent erythema, capillary dilation, atrophy, occasional papules and nodules that appear on the face after repeated external use of glucocorticoids, especially after the discontinuation of glucocorticoids for about 2 weeks the condition is aggravated and can be complicated by pustules. The efficacy of glucocorticosteroid treatment decreases gradually and needs to be escalated.
This disease is mostly seen in young and middle-aged women, and its main causes are inaccurate mastering of the indications for glucocorticoid use, inappropriate selection of drug varieties, large doses of drugs, and prolonged use of drugs. It may be related to hormone tolerance, hormones that encourage the overgrowth of microorganisms such as Propionibacterium acnes, or the effect of hormones on skin barrier function. Long-term use of glucocorticoids can cause a decrease in glucocorticoid receptors, and photosensitivity is also a contributing factor.
There is no unified standard for the diagnosis of hormone-dependent dermatitis. The diagnostic criteria are: (1) history of topical hormone use for more than 1 month; (2) recurrence and aggravation of the original disease or lesion 2-10 d after stopping hormone use; (3) subjective symptoms including pruritus, burning sensation, dry wrinkled sensation, pain; (4) objective symptoms including inflammatory papules or pustules, erythema, flushing edema, dry skin, flaking, enlarged pores, pigmentation hyperpigmentation, capillary dilation, and epidermal atrophy.
The treatment of this disease is complex and long-lasting, and should be carried out under the guidance of a doctor.
6. Follicular dermatitis.
It is a chronic inflammatory disease caused by worm mites parasitizing human hair follicles or sebaceous glands. Prevalent in young and middle-aged people, more men, can cause rosacea-like and acne-like rash and other types of rash, but no blackheads acne, more obvious in late spring and early summer. According to the rash can be divided into: acne type, rosacea type, mixed type, eczema type, scabies type, blepharitis type, blister type, pustular type, folliculitis type, seborrheic dermatitis type, etc. Treatment available metronidazole 0.2g, 3 times / day for 15 days.
7, perioral dermatitis.
Prevalent in women aged 20-35 years, may have a history of long-term use of fluoride hormones or fluoride toothpaste, damage can be symmetrically distributed in the nasolabial folds, perilabial and cheek areas, but the nose is not involved. There is a narrow “pale circle” around the red edge of the lips, and the main lesions are erythema, pinhead-sized red or skin-colored papules and papules, which are clustered and can be reduced to scaly erythema later, with a slight itching or burning sensation, and the lesions are sometimes light and heavy.
Internal tetracycline has been found to be effective. It has been suggested that the occurrence of perioral dermatitis is related to the coexistence of Helicobacter pylori infection in the patient and that concurrent treatment is beneficial for the recovery of perioral dermatitis.