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JAMA Pediatrics Clinical Challenge

An Unusual Inflammatory Rash

Image of figure 1


Robert M. Gathings, BE
John M. Abide, MD
Robert T. Brodell, MD

A 4-year-old, 15-kg girl presented with a 3-month history of a pruritic rash bilaterally on the cheeks, initially thought to be related to mosquito bites. Treatment with desonide, 0.05%, ointment twice daily proved to be ineffective. The patient’s rash also failed to clear with a therapeutic trial with griseofulvin liquid (125 mg/5 mL), 5 mL daily, and econazole, 1%, cream twice daily for 2 weeks and later ciclopirox, 0.77%, cream twice daily for 2 weeks, although the patient reported some improvement. The presence of persistent acneiform papules on the cheeks with postinflammatory hyperpigmentation led to a therapeutic trial of erythromycin, 400 mg/5 mL, 1.3 mL orally twice a day, with food. Test results for antinuclear antibody and rheumatoid factor were negative. Three weeks later, the patient presented with 2 slowly expanding, hyperpigmented, ringlike lesions with a tendency toward central clearing and peripheral scaling and erythema on the right cheek (Figure).

See the full article for an explanation and discussion.

Author Affiliations: Gathings is affiliated with the University of Mississippi Medical Center, Jackson, Abide with the Abide Dermatology Clinic, Greenville, Mississippi, and Brodell (rbrodell@umc.edu) with the Department of Dermatology, University of Mississippi Medical Center, Jackson, and University of Rochester School of Medicine and Dentistry, Rochester, New York.