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Picture of the Month—Quiz Case

Emma F. Johnson, BA; Erica G. Lau, DO; Aimee C. Smidt, MD
JAMA Pediatr. 2013;167(6):581. doi:10.1001/jamapediatrics.2013.328a.
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A 5-year-old girl presented with a 2½-year history of persistently dry, itchy, tender skin around the mouth. The mother denied frequent lip licking. Treatment involved topical antibiotics, hydrocortisone cream, and lip balms, without improvement. She was afebrile and otherwise healthy. There was no family history of similar dermatologic conditions. Examination demonstrated marked erythema and prominent scale periorally with blurring of the vermilion border (Figure 1). There was no warmth or drainage. Complete mucocutaneous examination revealed inflammation and edema of the upper gingival margins without ulceration. Her upper front teeth were covered with metal caps (Figure 2). Erythematous, scaly plaques on the bilateral earlobes were also noted (Figure 3).

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Figure 1. Well-demarcated perioral erythematous plaques with prominent scale and blurring of the vermilion border.

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Figure 2. Upper gingival margin with inflammation and edema. Upper front teeth were covered with metal caps.

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Figure 3. Eczematous plaques on the front (A) and back (B) of the earlobe.




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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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