Unilateral Facial Edema and Erythema in Late Pregnancy

Differential Diagnoses and Management

The American College of Obstetricians and Gynecologists recommends considering cellulitis or allergic/contact dermatitis as the most likely diagnosis for unilateral facial edema and erythema in late pregnancy, rather than a pregnancy-specific dermatosis, due to the atypical presentation of these conditions 1, 2
Atopic eruption of pregnancy (AEP) typically presents with bilateral eczematous rash on the face, eyelids, neck, antecubital/popliteal fossae, trunk, and extremities, not unilateral facial swelling, according to the American Academy of Dermatology 1, 2
Polymorphic eruption of pregnancy (PEP) causes pruritic urticarial papules and plaques on the abdomen and proximal thighs in the third trimester, not unilateral facial edema, as stated by the American College of Obstetricians and Gynecologists 1, 3
Intrahepatic cholestasis of pregnancy (ICP) presents with generalized pruritus without a primary rash and is not associated with facial edema or erythema, according to the American Liver Foundation 4, 1
Pemphigoid gestationis is a rare condition that presents with vesicles and bullae, not unilateral facial swelling, as reported by the National Institutes of Health 1

Facial cellulitis is a potential cause of unilateral facial edema, erythema, warmth, and tenderness, requiring urgent antibiotic therapy, as recommended by the Infectious Diseases Society of America 2
Erysipelas is a streptococcal infection that can cause well-demarcated erythema and edema, potentially dangerous if untreated, according to the Centers for Disease Control and Prevention 2
Dental abscess can cause unilateral facial swelling and requires dental evaluation, as stated by the American Dental Association 2

Allergic contact dermatitis can cause localized reaction due to new cosmetic, hair product, or environmental allergen, according to the American Academy of Dermatology 2
Angioedema can present unilaterally, although it is unusual, and requires assessment for airway involvement, as recommended by the American Academy of Allergy, Asthma, and Immunology 2
Insect bite reaction can cause localized hypersensitivity, leading to edema and erythema, as reported by the National Institutes of Health 2

The American College of Obstetricians and Gynecologists recommends immediate antibiotic therapy with pregnancy-safe beta-lactams for suspected cellulitis or erysipelas 2
Moderate-potency topical corticosteroids are safe for use on the face, according to the American Academy of Dermatology 3, 2
Chlorpheniramine is the preferred antihistamine due to its long safety record, as stated by the American Academy of Allergy, Asthma, and Immunology 2
Beta-lactam antibiotics are safe for use in pregnancy, according to the American College of Obstetricians and Gynecologists 2
Epinephrine should not be withheld in pregnancy if anaphylaxis is suspected, as recommended by the American Heart Association 5