Most Common Causes of Localized Facial Rash

Facial rashes are a common dermatologic skin problem that can affect any age, gender, or skin type. They can be embarrassing and stressful for the patient. In many cases, they can be treated easily, but other times they may herald internal medical problems.

What do facial rashes look like?

Facial rashes have a variety of presentations depending on the cause. It can appear red, pink, purple, or white discoloration on your face. The rash may be flat, scaly, raised, or have bumps or pustules (bumps with pus pocket on top). It may appear in only some areas of the face or all over the face.

What causes facial rashes?

There are many causes of facial rashes, but here are the most common ones.

Allergic contact dermatitis (ACD) occurs when the skin on the face comes in contact with a substance it is allergic to, such as nickel or poison ivy. The rash appears as itchy, pink scaly patches of skin that occur in the exact area that came in contact with the substance. Some severe cases can even have painful blisters.

Irritant dermatitis presents similarly to ACD with pink scaly patches in the area of contact with the irritant. Common irritants include soaps, acids in skincare products, and hair dyes.

Seborrheic dermatitis commonly appears on the face, scalp, and chest. The rash is characterized by pink patches with greasy white-yellow scales on the eyebrows, beard area, and around the nose. It is mildly itchy.

Atopic dermatitis in adults commonly presents as a pink, scaly rash in flexural areas, such as the wrist or behind the knees but may appear anywhere on the body. In children, it commonly appears on the face. It is believed to be caused by stress, environmental factors, hyperactive immune system, and genetics. The rash is very itchy.

Perioral dermatitis is caused by a reaction to certain skin products and appears with scaling and small pink bumps or pustules, similar to acne, around the nose and mouth. It can be itchy.

Acne occurs when skin pores get clogged with dirt, oil, and bacteria. It may present as blackheads, whiteheads, small or large pink bumps, pustules, and cysts. The smaller lesions may be mildly itchy, while the large pink bumps and cysts are painful.

Rosacea is characterized by redness, broken blood vessels, pink bumps, and pustules on the face. Some smaller lesions may be itchy, while larger ones are usually painful. It can look similar to acne.

Herpes simplex and zoster are caused by viral infections. Herpes simplex presents with a cluster of small blisters, usually on the lips or genitals, but they can appear anywhere on the body. Herpes zoster is characterized by grouped blisters that form along the distribution of nerves on the body. This gives zoster the classic pattern of blisters that encircle one side of the body in a linear grouping. These rashes are usually painful, and some report itching as well.

Tinea faciei is a fungal infection of the face. Patients usually present with a round pink circular rash with scaling on the outside of the circle and no scaling on the inside. Many refer to it as "ringworm" because of its round appearance, but it has nothing to do with worms. Many complain of itching associated with the rash.

Impetigo is a bacterial infection of the face usually caused by the bacteria Staphylococcus aureus. The rash may first appear as pink-red bumps or blisters that become yellow-crusty scabs. The rash can be tender and swollen.

There are other less common causes of facial rashes found in conjunction with internal diseases, such as lupus or dermatomyositis.

How does the doctor diagnose facial rashes?

In many cases, the dermatologist can diagnose facial rashes by examining your skin and asking you questions about the rash, your medications, and your medical history. However, in some cases, a skin biopsy and lab tests may be necessary.

How are facial rashes treated?

Treatment of facial rashes depends on the cause of the rash.

• Bacterial infections, like impetigo, respond to oral and topical antibiotics.
• Viral infections, like herpes simplex, are treated with oral or topical antivirals, while herpes zoster is treated with oral antivirals.
• Oral or topical antifungal medications effectively treat fungal infections, like tinea faciei.
• Depending on the severity of acne and rosacea, they can be treated with topical medications, such as antibiotics or retinoids, and oral medications, like antibiotics or isotretinoin.
• Perioral dermatitis is similar to acne and responds well to oral and topical antibiotics.
• Atopic dermatitis, seborrheic dermatitis, irritant dermatitis, and allergic contact dermatitis can be treated effectively with oral or topical steroids or steroid-sparing agents, like Protopic or Elidel. The culprit irritant or allergen must be discovered and eliminated to ensure the rash does not recur.

Facial rashes are a common skin problem. They can result from various causes, such as infections or inflammation. Most rashes are easily treated by a dermatologist, but some rashes may require consultation with an internal medicine doctor or rheumatologist. Always seek prompt treatment from a doctor when a rash appears.