Facial swelling
IMPORTANT The information provided is of a general nature and should not be used as a substitute for professional advice. If you think you may suffer from an allergic or other disease that requires attention, you should discuss it with your family doctor. The content of the information articles and all illustrations on this website remains the intellectual property of Dr Raymond Mullins and cannot be reproduced without written permission.
Introduction
There are a number of causes of facial swelling, some more common than others. The most common of those of hives/angioedema, contact allergic dermatitis, puffy eyes from having hay fever and rosacea. It is important to note that severity is not the same as being dangerous. A person with severe contact allergic dermatitis, for example, may have horrible symptoms but that is not likely to progress to anaphylaxis. Regardless of the cause, the risk of severe or dangerous tongue or throat swelling in a patient with non-allergic hives/angioedema is remote. If in doubt, photographing rashes and swelling can assist your doctor in diagnosis. Links to related articles are indicated below.
Hives look like mosquito bites, can be small or gigantic, and are generally itchy. They can occur over any part of the body where there is skin. Ongoing hives are not allergic in origin with drug allergy the exception to the rule. Most hives last less than 6 to 12 hours in one spot but they can occur daily for many days or weeks. Since the skin of the face is quite loose, swelling of the face can last longer than just a few hours, and is often called angioedema. This is not necessarily itchy but angioedema generally settles within 24 to 48 hours. If a person is getting itchy like hives of the body, then hives/angioedema is the most likely explanation. Antihistamines usually help but cortisone creams don't. Hives and angioedema do not cause rough dry scaly skin or peeling.
Eczema and contact allergic dermatitis
Eczema/dermatitis causes rough, dry, pink and scaly and itchy skin and can last for days or weeks at a time in one spot. Eczema is common in those who have allergies like hay fever and asthma. There is a genetic predisposition to having dry skin but dry skin and eczema can be worsened by exposure to soap, dry climate and winter heating. Some will also develop contact allergic dermatitis where localised dermatitis can occur the day following exposure, and can cause severe bouts lasting a week or two at a time, often with weeping sores. The sequence of events is often itchy and burning skin for by redness and swelling, sometimes weeping sores and dryness and peeling of the skin as it heals. This is an inflammatory rash so antihistamines are usually useless but cortisone creams or tablets if severe, usually help. If contact allergy is suspected, provocation or patch allergy testing can be undertaken.
Rosacea
This is most common in those of northern European genetic background. It can cause flushing, such as with changes in temperature or alcohol or caffeine and pimples of the forehead or cheeks years after acne should have disappeared. Sometimes big nasal pores are seen. Occasionally a person can develop red sore and dry irritable eyeballs. Subtle puffiness of the face can also occur, especially around the eyelids and forehead. The skin can be itchy or burning/painful. Nonetheless, one would not expect dramatic episodes of swelling or normally see skin peeling.
Drug reactions
Sometimes blood pressure tablets like ACE inhibitors can cause episodic swelling of the lips face or tongue which can be unpredictable. These episodes usually disappear within 24 hours and are not going to cause puffiness lasting days at a time. These episodes don’t necessarily occur every time the person takes the tablets, but rather occasionally. Those allergic to a drug like a painkiller can also developed similar symptoms within an hour or two of taken the tablet and again with disappearance within 12 hours or so. Food allergic reactions do not normally cause isolated face or tongue swelling. They normally cause itchy mouth, vomiting and generalised rash as well.
There are extra causes of swelling around the eyes such as allergic shiners in those who have hay fever, as well as the causes mentioned above. A person with hay fever and allergic conjunctivitis will also get watery eyes and puffy eyes. A person with severe sinusitis/sinus infection can sometimes develop dramatic swelling around the eyes. In those who have thyroid gland disease, sometimes the eyeballs can be pushed forward giving an appearance of swollen eyes. Blepharochalasia is another cause of localised swelling around the eyes. The cause is unknown but the skin doesn’t peel and antihistamines don’t help. Plastic surgery can assist. An infection known as a Stye can involves the eyelid margin that normally causes a localised redness and swelling which is painful and uncomfortable to touch.
The most common causes are again hives/angioedema or contact allergic dermatitis. Much less common causes include orofacial granulomatosis where one can get thick rubbery lips that developed over a long period of time. Links to causes of lip swelling are found here.
Uncommon causes of facial swelling
Underactive thyroid gland – this can trigger a diffuse appearance of facial puffiness, but there is no itching or peeling of the skin.
Blockage of the superior vena cava – a blockage of the veins helping the face and neck to drain can cause fluid accumulation around the face, often worse in the morning and better during the day when a person is upright. Enlarged lymph glands or cancer pressing on the blood vessel can cause this. I have only seen one case in 25 years.
Low blood protein – low blood protein can allow fluid to move from blood vessels into the tissues, especially when a person is lying flat. This is usually worse in the morning and better during the day.
Fluid retention – blood protein may be normal but this can end up with a similar appearance; puffy face in the morning and better during the day.
Cellulitis – this is a skin infection with red hot swollen burning skin, usually accompanied by symptoms are feeling unwell and fever. Lymph glands in the neck can be swollen. This is a medical emergency needs medical attention and use of antibiotics.
Pre-eclampsia – this only occurs during pregnancy and can cause fluid retention and very high blood pressure. This is also a medical emergency requires urgent medical attention. A person may also have other symptoms like headaches or visual changes at the same time.
Swelling of the lymph glands – if the lymph glands are swollen underneath the chin and jaw line and localised swelling can occur. The most common trigger is infection in which case the lymph glands are tender in a person normally feel sick. Painless lymph gland enlargement can occur in young children with eczema or in some types of cancer like lymphoma in older people.
Swelling of the saliva glands – glands producing saliva occur in front of the ears (parotid-glands) and in the neck underneath the chin and jawline. The most common trigger is Sjogren syndrome where one gets inflammation of the salivary and tear glands resulting in dry mouth and dry eyes, respectively. A less common cause is an inflammatory condition called sarcoidosis.
Last reviewed 8 July 2020
