The cheeks constitute the largest area of the face and may be affected by various conditions that are often signs of underlying infections or systemic diseases (e.g., the “slapped cheeks” of erythema infectiosum and the “butterfly rash” of systemic lupus erythematosus; both are discussed in Chapters 21 and 22). Also, various benign, premalignant, and malignant lesions are found on this sun-exposed location.

In infants, atopic dermatitis and acne occur on the cheeks and often appear at less than 1 year of age. Teenage acne (acne vulgaris), adult-onset acne, and rosacea, as well as pigmentary disorders e.g., vitiligo, pityriasis alba, and melasma, also are seen on the cheeks. Infections such as impetigo and tinea commonly arise on the cheeks and paranasal regions.


Atopic Dermatitis (Atopic Eczema)

Atopic Dermatitis

Infantile Phase

Distinguishing Features

  • The face and/or scalp is involved in almost all affected infants

  • Skin lesions present with varying amounts of ill-defined, scaly, erythematous, edematous, papules and plaques on the cheeks, forehead, and scalp

  • Lesions are bilaterally symmetric with classic red, glazed, scaly cheeks (Fig. 7-1)

  • Oozing and secondary infection (impetiginization) with Staphylococcus aureus is common. Impetiginization of eczema is characterized by yellow or varnish-colored crusting overlying the eczema lesions (Fig. 7-2)

  • Sleep is disturbed due to associated pruritus

  • The infant is often irritable and itchy as indicated by rubbing the scalp and head on crib bedding, by pinching, scratching, or tapping the skin

Childhood Phase

Distinguishing Features

  • The childhood phase of AD follows the infantile phase beginning at around 2 years of age and continues through puberty. Lesions, which often continue to involve the face, also begin to localize to the flexural aspects of the elbows and knees (antecubital and popliteal fossae), the wrists, ankles, and the posterior neck in a symmetric distribution. Lesions may also occur on the lips, scalp, and behind the ears.

    • Itchy, scaly, erythematous plaques appear on the face

    • Frequently become infected (impetiginized) with S. aureus

    • The secretion of toxins (superantigens) by S. aureus may trigger relapses of AD; also herpes simplex virus may attack the relatively defenseless eczematous skin and result in Kaposi varicelliform eruption (eczema herpeticum) (Fig. 7-3) which requires treatment with oral or systemic antiviral medications, such as acyclovir or valcyclovir

Adolescent Phase

Distinguishing Features

  • There are few areas of the skin that are ignored by eczema. The predominant areas of involvement continue to be the flexural surfaces (see Figs. 13-9, 13-10, 13-11); in addition, the dorsal aspect of the hands and feet are also commonly affected. Lesions also may appear in other extensor locations such as the shins, ankles, feet, and the nape of the neck. Sometimes lesions are limited to the lips (atopic cheilitis), eyelids, vulvar or scrotal areas

Port Wine Stain (Nevus Flammeus)

Distinguishing Features

  • A PWS presents at birth as a flat, well-demarcated, pink to dark red (“port-wine” color) blanchable patch, most commonly noted on the face (Fig. 7-4)

  • PWSs are usually unilateral but can be bilateral

  • Lesions darken progressively and can become thickened over time. Some develop secondary proliferative nodules on their surface

Infantile Hemangioma (See Also Figs. 2-4, 2-5, 2-6)

Distinguishing Features

See Scalp

Pityriasis Alba

Distinguishing Features

  • Asymptomatic or slightly itchy

  • Lesions most often appear on the cheeks (Fig. 7-6) and lateral upper arms (see Fig. 13-3)

  • Present as one or more round, oval, or irregular whitish patches or thin plaques, with or without fine surface scale

  • Often appears following sun exposure because tanning of surrounding skin unmasks affected areas

Keratosis Pilaris

Distinguishing Features

  • KP presents as an eruption of grouped, follicular, tiny keratotic papules resulting in a sandpaper-like texture when palpated

  • Distributed in a grid-like pattern

  • In children, the lateral sides of the cheeks are frequently involved (Fig. 7-7)

  • Usually worsens during the winter months

  • When erythematous and inflamed, KP is referred to as keratosis pilaris rubra faciei (Fig. 7-8)

  • The condition is mostly of cosmetic significance

Neonatal Acne (Neonatal Cephalic Pustulosis)

Distinguishing Features

  • Erythematous papulopustules (Fig. 7-9)

  • Unlike infantile and adolescent acne, there are no comedones and the course is self-limiting

  • Eruption is asymptomatic

  • Resolves spontaneously in weeks to months

Infantile Acne

Distinguishing Features

  • Appears similar to typical acne vulgaris that is seen in adolescence with an admixture of acneiform papules, pustules, open and closed comedones, and cysts (Fig. 7-10)

  • Lesions are typically located on the cheeks, but can also be seen on the forehead, chin, and back

  • Cysts, draining sinuses, and deep nodules with potential for scarring occasionally occur

  • Onset is between 3 and 6 months and subsides at around 1 to 2 years of age commiserate with the normalization of androgen levels

Acne Vulgaris (Teenage Acne)

Distinguishing Features

  • Inflammatory lesions consist of papules, pustules (Fig. 7-11), and acne “cysts” (nodules)

  • Noninflammatory (comedonal acne) lesions appear as open comedones (“blackheads”) and closed comedones (“whiteheads”) (Fig. 7-12)

  • Mild acne consists of open and closed comedones and/or occasional papules and pustules

Jan 8, 2023 | Posted by in Dermatology | Comments Off on Cheeks

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