Chronic Bilateral Malar Rash Diagnosis and Management
Differential Diagnosis
- Atopic eczema would typically present with itchiness in skin creases, general dry skin, and often has onset in early childhood rather than chronic adult presentation, as noted by the British Medical Journal 1, 2
Diagnostic Considerations
- Contact dermatitis would require exposure history to specific allergens or irritants, and patch testing would be indicated if suspected, according to the British Journal of Dermatology 3
- Seborrheic dermatitis usually involves scaling and affects seborrheic areas including nasolabial folds and eyebrows, as reported by a medical insights journal, however, a non-Praxis source is preferred but not available 4
Special Considerations
- Drug-induced rash, such as papulopustular eruptions from EGFR inhibitors and MEK inhibitors in cancer patients, develop within days to weeks of starting therapy and affect 75-90% of patients, as discussed in the Annals of Oncology 5, 6
- Bacterial infection should not be assumed without evidence, while bacterial colonization can occur in rosacea, routine bacterial cultures are not indicated unless there is crusting, weeping, yellow discharge, or failure to respond to standard therapy, as noted in the Annals of Oncology 7, 8