Clinical Presentation of Facial Dermatitis

Primary Morphologic Features

The American Academy of Dermatology notes that facial dermatitis presents with erythema, edema, xerosis, erosions/excoriations, oozing and crusting, and lichenification, with findings varying by patient age and chronicity of lesions 1, 2
Erythematous papulovesicular lesions with excoriation and serous exudate are characteristic of acute presentation 3
Edema of affected facial areas is a common feature 1, 2
Oozing and crusting, particularly when secondary bacterial infection is present, are notable signs 1, 2, 4, 5
Grouped, punched-out erosions or vesiculation suggesting herpes simplex superinfection may occur 4, 5
Lichenification from chronic rubbing and scratching is a hallmark of chronic presentation 1, 3, 6
Xerosis, or generalized dry skin, is a characteristic feature of facial dermatitis 1, 6
Papules and excoriations in chronically affected areas are common 3

In infants and young children, cheeks and forehead involvement is characteristic 4, 5
Outer limbs are commonly affected in this age group 4, 5
Sparing of groin and axillary regions helps distinguish facial dermatitis from seborrheic dermatitis 1
In older children and adults, periorbital involvement with eyelid eczema may occur 7
Perioral distribution and neck involvement with itchiness in skin creases are possible 1, 4, 5

Crusting or weeping beyond baseline presentation may indicate secondary bacterial infection 4, 5, 6
Honey-colored crusts suggest Staphylococcus aureus infection 4, 5
Grouped, punched-out erosions or vesiculation may indicate herpes simplex superinfection 4, 5

Evidence of scratching, such as excoriations and shortened nails, is common 4, 5
Pruritus is a hallmark feature of facial dermatitis 1, 2
Lymphadenopathy may be present secondary to extensive skin disease 4, 5
Periorbital darkening, or Dennie-Morgan folds, may occur in chronic cases 1

The American Academy of Dermatology notes that contact dermatitis may be indistinguishable from atopic dermatitis on examination alone and should be considered when facial dermatitis has atypical or localized distribution 1, 4, 5
Patch testing is essential when contact allergy cannot be ruled out, particularly with persistent facial eczema 7, 8
Seborrheic dermatitis overlaps with atopic dermatitis in infancy but typically shows greasy scale in scalp and folds, affects groin/axillary regions, and lacks significant pruritus 1