The red face revisited: connective tissue disorders.

Area of Science:

• Dermatology
• Rheumatology
• Internal Medicine

Background:

• Facial redness is a common symptom in various connective tissue disorders.
• Cutaneous manifestations, particularly facial erythema, aid in diagnosing systemic lupus erythematosus (LE), systemic sclerosis, and dermatomyositis.

Purpose of the Study:

• To review and differentiate the various causes of facial redness in connective tissue diseases.
• To highlight key clinical signs for accurate diagnosis.

Main Methods:

• Review of clinical presentations of facial erythema in systemic lupus erythematosus (LE).
• Analysis of cutaneous findings in systemic sclerosis, including telangiectasias.
• Examination of heliotrope sign and other facial rashes in dermatomyositis.

Main Results:

• Systemic LE commonly presents with a malar eruption sparing nasolabial folds; subacute LE can mimic this after sun exposure.
• Chronic cutaneous LE includes discoid lesions and rarer forms like erythema perstans faciei.
• Facial telangiectasias are frequent in systemic sclerosis, especially CREST syndrome, and correlate with disease severity.
• Dermatomyositis is characterized by heliotrope (violaceous eyelid) erythema, which can extend to the face and trunk.

Conclusions:

• Distinct facial eruption patterns are crucial for differentiating connective tissue diseases.
• Associated symptoms and specific lesion characteristics (e.g., sparing of nasolabial folds, heliotrope eyelids) are key diagnostic clues.