Erythema with Special Topography

Abstract

Red lesions of the face are common. A midfacial telangiectatic erythema which spares the mobile areas such as the eyelids and lips is typical of rosacea. A scaly erythema in areas rich in sebum, around the eyebrows, glabella, and nasolabial folds, is characteristic of seborrheic dermatitis. These two disorders, along with acne, are the most common causes of facial dermatitis, with a prevalence of 2–4 %. However, several other diseases can cause facial erythema. Flushing accompanied by facial erythema must be distinguished from permanent erythema. Certain paroxysmal erythemas have a special topography which gives an etiological orientation, e.g., hemifacial erythema in Harlequin syndrome points to an injury of the second sympathetic ganglion. Other erythemas appear in particular circumstances such as during meals and can be accompanied by hyperhidrosis as in Frey’s syndrome, following injury of the auriculotemporal nerve and anomalous regeneration of the sympathetic fibers that supply the sweat glands instead of the parotid. The timing can also be suggestive, as in postprandial erythema occurring in a dumping syndrome, which is a classic complication of esophagogastric surgery. Onset related to certain characteristic circumstances can give a clue to diagnosis, such as cold temperature (cryoproteins) or hot temperature (red ear syndrome, a variant of erythermalgia) or certain drugs. Permanent, nonparoxysmal lesions must be classified according to their onset, which can be either sudden or progressive. It is essential to determine the presence of associated cutaneous lesions through physical examination: pustules, papules, plaques, and extracutaneous signs, particularly fever or chills, and joint pain. Sometimes, only history taking can reveal the existence of associated lesions, since these may not be present during examination. It is important to specify whether the lesions are photo-induced and/or photo-exposed (cf. Chap. 10). Chondritis may be the consequence of an inflammation of the cartilage, thus causing erythema in cartilaginous areas such as nose wings or pinna while sparing the lobule. Causes of erythematous papules and plaques of the face will be summarized here for teaching purposes.