Spreading Facial Scabs: Causes (Impetigo, Ringworm, Eczema) & Treatment

Spreading scabs on the chin/face suggest an active infectious or inflammatory process requiring diagnosis.

Top Differential Diagnoses

Immediate Actions

1. See a clinician (dermatology/urgent care) today. Bacterial/viral cultures, KOH prep, biopsy if needed.
2. Stop touching/scratching. Trim nails.
3. Gentle cleansing: Mild soap, water; pat dry.
4. Do not self-medicate with steroids (worsens infection) or antibiotics (resistance).

Treatment Principles

• Impetigo: Topical mupirocin (localized) or oral cephalexin/doxycycline (widespread).
• Tinea: Topical terbinafine/clotrimazole × 2–4 weeks; oral if extensive.
• SSSS: IV antistaphylococcal penicillin (nafcillin) + supportive care.
• Eczema herpeticum: IV acyclovir (dermatology emergency).
• Scabies: Permethrin 5% cream neck-down × 8–14h, repeat 1 week; treat contacts.

Correct diagnosis = correct treatment. Don't guess.

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Condition	Key Features	Transmission
Impetigo	Honey-colored crusts on erythematous base; starts as vesicles/pustules	Highly contagious (contact, fomites); S. aureus, GAS
Tinea faciei (Ringworm)	Annular, scaly, advancing border; central clearing	Contact (human, animal, soil); dermatophytes
Staphylococcal Scalded Skin Syndrome (SSSS)	Generalized erythema, Nikolsky sign, desquamation; no mucosal involvement	Toxin-mediated (exfoliatins); S. aureus phage group II
Eczema herpeticum	Punched-out erosions, vesicles on eczematous skin; fever	HSV superinfection; emergency
Scabies	Burrows, intense nocturnal itch; finger webs, wrists, genitals	Mite (Sarcoptes); prolonged contact
Contact dermatitis	Vesicles, weeping, geometric distribution	Allergen/irritant exposure