Often, but not always bilateral

Abrupt onset over minutes to hours; may follow an exposure

Scaling usually absent

Often self-limited; avoid inciting agents

Emergency medical attention is required in patients with upper airway obstruction; administer 0.3 mg of intramuscular epinephrine

Mild cases may benefit from oral antihistamines and/or glucocorticoids:

Diphenhydramine hydrochloride (Benadryl), 25 to 50 mg three or four times daily (dosage for children: 4 to 6 mg per kg per day, in three or four divided doses)

Loratadine (Claritin), 10 mg daily (dosage for children two to five years of age: 5 mg daily)

Prednisone, 0.5 to 1.0 mg per kg per day, then taper after three or four days

Fine scaling usually present

Less edema than with contact dermatitis

Other signs of atopic dermatitis may be present

Family or personal history of allergic rhinitis or atopic dermatitis

Oral antihistamines (see above)

Topical corticosteroids:

Desonide (Tridesilon) 0.05%

Alclometasone dipropionate (Aclovate) 0.05% twice daily for five to 10 days

Second-line treatments:

Tacrolimus (Protopic) 0.1% ointment twice daily

Pimecrolimus (Elidel) 1% cream twice daily

Yellow scaling at eyelid margins

Patients may have pruritus or burning

Less edema than with cellulitis or contact dermatitis; edema more prominent at eyelid margin

Local measures: eyelid massage, warm compresses, and gentle scrubbing twice daily with a cotton swab and 1:1 solution of dilute baby shampoo or commercially available eyelid cleanser

For staphylococcal infections, bacitracin or erythromycin ointment to eyelid margins at bedtime or one to two weeks

For meibomian gland dysfunction, may add tetracycline, 250 mg four times daily, or doxycycline (Vibramycin), 100 mg three times daily, then taper after four weeks

Onset follows exposure

Pruritus in allergic contact dermatitis; burning or stinging in irritant contact dermatitis

Minimal scaling

Edema may be profound

Avoid inciting agents

For allergic dermatitis, desonide 0.05% or alclometasone dipropionate 0.05% cream or ointment twice daily for five to 10 days

For irritant dermatitis, cool compresses and a petroleum-based emollient applied at bedtime

Telangiectasias often present

Onset over weeks to months

Eyelid changes often accompany flushing, papules, and pustules of the nose, cheek, forehead, and chin

Local measures as for blepharitis

Systemic tetracyclines:

Tetracycline, 250 mg four times daily

Doxycycline, 100 mg three times daily

Topical metronidazole 0.75% cream (Metrocream) or gel (Metrogel) twice daily

Azelaic acid gel (Finacea) twice daily

Onset over weeks to months

Other cutaneous and systemic findings present

Maximize treatment of the underlying disorder

Often presents with severe edema, deep violaceous color, and pain

Onset over hours to days

History of preceding trauma or bite

Suggested oral regimen for patients with preseptal cellulitis only†:

Amoxicillin/clavulanate (Augmentin), 875 mg twice daily or 500 mg three times daily (dosage for children older than three months: 40 mg per kg three times daily; dosage for children younger than three months: 30 mg per kg every 12 hours)

Suggested intravenous regimens:

Ampicillin/sulbactam (Unasyn), 1.5 to 3 g every six hours (dosage for children: 300 mg per kg daily, divided every six hours)

Ceftriaxone (Rocephin), 1 to 2 g daily or divided every 12 hours (dosage for children: 50 to 75 mg per kg daily, divided every 12 hours)

Parenteral antibiotics are often given for seven days in orbital cellulitis; transition to oral antibiotics if clinical improvement is noted after one week, to complete a total treatment course of 21 days

Vesicles often present

Pain or burning may be present

Onset over hours to days

Often self-limited; use supportive measures such as compresses

Topical bacitracin may help prevent secondary infection

Recurrent cases can be treated with long-term suppressive therapy:

Acyclovir (Zovirax), 400 mg twice daily

Valacyclovir (Valtrex), 500 mg to 1,000 mg daily

Famciclovir (Famvir), 250 mg twice daily

Older adults

Vesicles often present

Pain or burning

Onset over hours to days

Cool compresses

Acyclovir, 800 mg five times daily for seven to 10 days; valacyclovir, 1 g three times daily for seven days; or famciclovir, 500 mg three times daily for seven days

Early initiation of tricyclic antidepressants (desipramine [Norpramin], 25 to 75 mg at bedtime) may inhibit postherpetic neuralgia

Patients may require additional treatment for complications such as keratitis and glaucoma

Older adults

Insidious onset

Typically painless nodule

Depending on tumor type, Mohs micrographic surgery or wide local excision