Facial swelling, differential diagnosis

The differential diagnostic considerations can be organized according to the following algorithm:

• Localization of the swelling (e.g. eyelid, cheek, lip, forehead)
• Type of swelling:
  • localized
  • diffuse (evenly distributed).
• Acuity:
  • acute = < 6 weeks
  • chronic = > 6 weeks.
• Color:
  • red
  • non-red.
• Painfulness:
  • yes
  • no.
• General symptoms:
  • e.g. fever, swelling of lymph nodes
• e.g. acute or chronic internal diseases.
• Clinical conditions or symptoms:
  • Diffuse, acute, red, facial swelling
  • erysipelas
  • Initial zoster
  • Initial or accompanying phenomenon in infectious exanthema (e.g. in viral exanthema (see exanthema (DD) below)
  • Diagnostic symptom in erythema infectiosum (sore ear)
  • Angioedema
  • Hereditary angioedema
  • Diffuse, acute and/or chronic facial swelling in dermatomyositis or systemic scleroderma
  • Urticaria (acute)
  • Erythrophobia (erythema e pudore)
  • Flushing phenomena
  • Contact allergic or toxic eczema of the face (also collateral in acute eczema of the capillitium e.g. after dyeing the hair or after excessive UV exposure of the face).
• Diffuse, chronic, red, facial swelling:
  • Rosacea erythematosa
  • Rosacea fulminans
  • Acne conglobata
  • Acne fulminans
  • Cutaneous hemangioma of the infant (swelling depending on location; e.g. cheek, lip, eyelid)
• Diffuse, acute and/or chronic facial swelling:
  • dermatomyositis
  • systemic scleroderma
  • Erythema perstans faciei
  • M. Morbihan
  • Urticaria (chronic)
  • Edema in chronic alcoholism (see below alcohol, skin changes and facies ethylica)
  • Melkersson-Rosenthal syndrome.
• Diffuse, acute/chronic, non-red, facial swelling:
  • Subcutaneous hemangioma of the infant (swelling depending on localization; e.g. cheek, lip, eyelid)
  • Facial edema in nephritis and nephrosis (see also kidney diseases, skin changes)
  • Facial edema in chronic terminal renal insufficiency
  • Facial oedema in thyroid dysfunction
  • Plaque-like, cutaneous mucinosis (see below [ Mucinosis(s)])
  • Facial edema in case of influence congestion
  • Facies lunata as a symptom of Cushing's syndrome
  • Hunger edema
  • Pseudoangioedema in facial nerve palsy
  • (Post-)traumatic edema (persistent swelling after severe facial trauma)
  • Post-operative facial edema (persistent collateral swelling of the face after major flap surgery in the facial area).
• "Thick cheek" (acute/chronic):
  • Swelling of the parotid gland of various etiologies (DD: diseases of the parotid gland)
  • Acute apical periodontitis (often with an avital tooth)
  • Dentitio difficile (difficult eruption of a wisdom tooth)
  • Root granulomas with fistula formation
  • Chronic osteomyelitis
  • Parulis
  • Emphysema (e.g. after dental treatment, e.g. due to dry blowing of a drilled root canal)
  • Fistula formation after lymph node tuberculosis
  • Actinomycosis (type of cervico-facial actinomycosis).
• Lip swelling (acute/chronic):
  • Collateral lip swelling in aphthae of various etiologies
  • Herpes simplex labialis (see below herpes simplex recidivans)
  • Lip furuncle
  • Cheilitis granulomatosa
  • Ascher syndrome
  • Chronic cheilitis glandularis
  • Tapir snout in Melkersson-Rosenthal syndrome
  • Carcinoma, lip carcinoma

Detection and elimination of the cause, if necessary careful internal or allergologic clarification.

For swelling in the morning: cooling compresses, e.g. compresses soaked in black tea. As an alternative, "cool packs" are possible.

For treatment of eyelid swelling, see there.

1. Velasco-Amador JP et al. (2024) If not angioedema, what is it? Diagnostic approach to facial edema. J Dtsch Dermatol Ges 22: 501-512.