Pain in the face may either be due to local disease of any of the major structures of the face, or conditions affecting the innervation. The latter can occur anywhere between the posterior fossa and the ends of the trigeminal nerve. A good examination is not difficult, and quicker than most as undressing is not usually required.
Unlike most of the other ‘skin’ sections, this section is presented according to the rash’s distribution. This is because it is a common presentation, one with a wide differential and one which causes the patient significant concern, largely because of the cosmetic impact. Occasionally, it can be caused by, or represent, significant pathology. Individual facial spots – such as basal cell carcinoma – aren’t considered here.
This section looks at ‘internal’ causes of facial swelling rather than superficial skin conditions, which are dealt with in other sections. This problem is usually a major concern to the patient because of the disfigurement, which it is impossible to hide. The causal conditions are often very painful too.
Facial ulcers and blisters present much earlier than similar lesions elsewhere on the body because of the cosmetic disfigurement. Smaller lesions, especially basal cell carcinomas, are often picked up coincidentally by the doctor when the patient attends for some unrelated matter. (NB: For rashes confined, or largely confined, to the face, see 'Facial rash'.)