2. Facial erythema (facial redness):
• Cutaneous blood vessel dilation and increased blood flow to the
skin
• Clinical finding
• Most noticeable in fair-skinned individuals
• Often observed as a normal, neurologically-mediated response to
strong emotion, exercise, or heat exposure, inflammation and a
variety of medical conditions can lead to longer-lasting and
symptomatic or cosmetically distressing facial erythema.
3.
4. Lesion symptoms distribution ttt
Eczema Acute :bullous,
chronic: pink
lichenified
Itchy, dry, burning Allergic: areas of
exposure Atopic:
spares central
face
Topical steroid
Topical calcineurin
inhibitor
Rosacea Erythema ,
telangiectasia,
±pink papules
±rhinophyma
Burning ,redness
Worsened by alcohol,
hot or spicy foods, etc
Concavities of
face: forehead,
cheeks, nose,
chin also eyes
Topical
antibiotics ,Oral
doxycyline
Seboeehea Greasy +
yeloowish scales
- Scalp, brows,
nasal crease,
behind ears
Topical st .Topical
CCIs
Acne Comedons,
papules, pustules
- Cheeks, forhead,
chest, back
Topical antibiotics
topical retinoids
Oral antibiotics
lupus Pink-Red-Brown,
Annular Variable
scale Variable
Scarring
Acute (malar):
cheeks, without
crossing
nasolabial fold
DLE: Sun-
exposed areas
and inside ear
Topical steroids
Antimalarial
Tinea Pink annular,
patches and
plaques with
Anywhere with
stratified
squamous
Topical or oral
antifungal
5. • The first step for narrowing the differential diagnosis of
facial erythema is the performance of a thorough patient
history and skin examination.
• The recognition of associated symptoms, exacerbating
factors, lesion time course, and subtle clinical features of
the affected area are often valuable for diagnosis. In
addition, the performance of a full skin examination may
yield additional skin findings that suggest an underlying
cutaneous or systemic disorder
15. • Heat exposure
• Sun exposure
• Hot beverages
• Hot, spicy foods
• Alcohol
16. • Chronic case, long term therapy
• Avoidance of factors that exacerbate
• treatments differ according to patient’s
manifestations
• Types of treatment include
Topical products: metronidazole, sodium
sulfacetamide, azelaic acid, sulfur cleansers
Oral antibiotics or isotretenoins for pustular and
papular lesions
19. • Site: cheeks, the bridge of the nose, the ears, the side of
the neck and the scalp.
• Erythematous, indurated plaques
• covered by an adherent scale
• Follicular plugging
DLE scar:
• depressed central scars
• Atrophy, telangiectasias
• hyperpigmentation and/or hypopigmentation
20. • Serositis
• Oral or nasopharyngeal ulcers: usually painless; palate is most specific
• Arthritis
• Photosensitivity
• Blood disorders: Leukopenia, lymphopenia, thrombocytopenia, hemolytic
anemia
• Renal involvement : proteinuria or cellular casts
• Antinuclear antibodies (ANAs) - Higher titers generally more specific
• Anti dsDNA; anti-Smith (Sm) antibodies; antiphospholipid antibodies
biologic false-positive serologic test results for syphilis, lupus
erythematosus (LE) cells
• Neurologic disorder
• Malar rash
• Discoid rash
21. Sun-protective measures
Standard medical therapy:
• Topical or intralesional corticosteroids
• Antimalarials.
• Topical calcineurin inhibitors
• Recalcitrant disease: including methotrexate,
mycophenolate mofetil, and thalidomide
• Systemic corticosteroids are avoided
22.
23.
24.
25. • History of sun
exposure
• Erythema.
• Pain, tenderness,
hotness and itching.
• Swelling.
• fluid-filled blisters
• Headache, fever,
nausea and fatigue.
27. Skin Type Response to sun exposure Phenotype
I Burn easily and severely
Tan little or not at all
Red or blond hair
Blue or brown eyes
II Usually burn easily
Tan minimally or lightly
Red, blond or brown hair
Blue, hazel, or brown eyes
III Burn moderately
Tan gradually and uniformly
Average Caucasian skin
IV Burn minimally
Tan easily
Dark brown hair
Dark eyes
White or light brown skin
V Rarely burn
Tan well and easily
Brown-skinned (Middle
Eastern and Hispanic)
VI Almost never burn
Tan profusely
Black skin
28. phototoxic photoallergic
Direct drug-UVR interaction
generate singlet oxygen
UVR convert drug to
immunologically active compound
Exaggerated sunburn Dermatitis or lichen planus like
Acute Chronic
Sun-exposed areas Exposed + protected areas
29.
30. DO:
• Soothe hot, burning skin by applying a cool compress or water
• Apply moisturizer frequently, especially right after bathing
• Choose a hypoallergenic, fragrance-free cream which is less occlusive
than an ointment
• Consider using systemic analgesic/anti-inflammatory medications
such as NSAIDS
• Consider mild topical corticosteroids which may bring some relief
DON’T:
• Use potentially irritating treatments such as topical lidocaine or
benzocaine preparations
31. Phototoxic Photoallergic
Incidence High low
Amount of agent
required
large small
Onset Acute (minutes-hours) 24-72 hours
Involved areas Exposed Exposed and
nonexposed
Multiple exposure
required
No Yes
clinically Sunburn Sunburn
Immunological
reaction
No Type IV
36. Cutaneous
manifestations
• Gottron’s papules
• Dilated capillary loops of
the nail folds
• Calcinosis cutis
• Raynaud’s phenomenon
Amyopathic DM
muscle
involvement
muscles weakness (±
painful and tender)
• difficulty in going up
stairs or rising from a
chair
• difficulty in raising the
arms high enough to
comb the hair
Polymyositis
40. 1- Rest is essential in the acute phase
2- Physical therapy is useful to help prevent the
contractures
3- sun avoidance and sun protection measures
- Corticosteroids: dose depends on activity
Starting: 60-120 mgday
maintenance: 5-15 mgday
- Azathioprine
- methotrexate
