Visual summary Periocular rash: diagnosis guide

Skin problems around the eyes can be HISTORY MORPHOLOGY DISTRIBUTION challenging to diagnose because of a wide Start by taking a Presence or absence Consider examining differential. It can be useful to combine focused history of of inflammation can the whole skin information from a focused history of the the rash, including be important, as can surface, not just the rash with a detailed examination time course and the appearance of periocular site symptoms any erythema Acute onset conditions Lymphoedema Swelling is usually permanently Periocular swelling without Swelling of the face and neck present but is often worse in significant erythema is common Oedema with mornings no erythema Angioedema Acute, often dramatic onset Periocular swelling without Often associated with significant erythema. Wheals oedema of lips, tongue, and may be present larynx

Contact allergic Typically presents 24 to 48 hours Scaly rash. Papules may also be Localised or generalised, with dermatitis after exposure to an allergen present rash starting at the point of Presence of contact erythema Irritant Caused by direct irritant effects of Scaly rash. Papules may also be Tends to be localised to a substance that has been in present affected site; the eyelids are dermatitis contact with the skin particularly susceptible

Erysipelas Acute spreading infection Erythema with visually indistinct Principally involves the borders, oedema, warmth, and dermis and subcutaneous Systemically tenderness tissue unwell Periorbital Infection may be due to Erythema with visually indistinct Occurrs in the eyelid tissues superficial tissue injury (such as borders, oedema, warmth, and superficial to the orbital cellulitis insect bite or chalazion tenderness septum

Chronic conditions HISTORY MORPHOLOGY DISTRIBUTION Atopic eczema May be personal or family history Itchy erythema with papules, Often affects the upper of atopy plaques, and associated eyelids. Flexural involvement Relevant epidermal scale common personal or family history Psoriasis Can be triggered by illness, stress, Erythematous scaly plaques, Usually around the eyes, but or drugs sometimes associated with can also koebnerise into areas blepharitis of trauma or dermatitis

Seborrhoeic Associated with chronic Scaly erythematous rash. Affects highly sebaceous areas. Scaly erythema neurological conditions including Papules may also be present On head: eyebrows, forehead, dermatitis Parkinson’s disease nasolabial folds, ears, and scalp

Papules, Rosacea Characterised by episodes Combinations of erythema, Mainly around the central face. pustules, or of remission and recurrence telangiectasia, papules, and May also feature eyelash telangiectasia pustules 'dandruff', gritty feeling eyes Perioroficial Often seen in those who have Erythematous papules and Often around the mouth, History of been using topical or inhaled pustules with sparing of the vermillion steroid use dermatitis corticosteroids border

Congenital Longstanding conditions such Vascular malformation: port-wine Congenital naevus may affect as vascular malformation and stains; Congenital naevus: benign the eyelid, sclera, and Dyspigmentation dyspigmentation congenital naevus brown or black naevi conjunctiva, or just the eye the predominant feature Acquired Vitiligo, facial melanosis, systemic Altered pigmentation. Generally Various, depending conditions, melanocytic lesions, more prominent in darker skin on underlying cause dyspigmentation and exogenous causes types

Photosensitive Differential includes cutaneous Erythema on prominences of the Sparing of shaded parts Photodistributed lupus, dermatomyositis, and face (cheeks, nasal bridge, and of the face, such as upper rash other connective tissue disorders ears) eyelids and behind ears

Disclaimer: This infographic is not a validated clinical decision aid. This information is provided without any representations, conditions, or warranties that it is accurate or up to date. BMJ and its licensors assume no responsibility for any aspect of treatment administered with the aid of this information. Any reliance placed on this information is strictly at the user's own risk. For the full disclaimer wording see BMJ's terms and conditions: http://www.bmj.com/company/legal-information/