Ayman Samkari, MD

Scleroderma may present at any age and can be localized or systemic. Localized scleroderma affects the skin, subcutaneous fascia, and occasionally muscle and bone. Systemic scleroderma is characterized by chronic disease with both skin changes and visceral abnormalities. Rarely, localized scleroderma may progress to systemic disease; however, screening for this form is unnecessary in patients who have no systemic symptoms.1-5

For 3 weeks, a 3-year-old African American boy had a mildly pruritic rash on his buttocks, lower extremities, upper thighs, and soles. The patient was initially seen at an urgent care center, where he was given amoxicillin for suspected scarlet fever. A week later, he presented to the emergency department and was treated with griseofulvin for tinea corporis. A skin culture did not grow fungus.

The child's mother recalled that the rash started as a single patch on his lower back and that the child had an upper respiratory tract infection 4 weeks earlier.

A 4-year-old girl presented with a sore throat, dysphagia, fever (temperature up to 40°C [104°F]), and a pruritic vesicular rash. On the first day of the illness, 4 days earlier, she was evaluated by her pediatrician who prescribed azithromycin for a presumed upper respiratory tract infection. About 2 days later, a papular rash developed on the abdomen and perioral skin; the fever had persisted, and the child's oral intake had decreased. The next day, the rash continued to spread, and the patient refused to take anything orally, including fluids. The mother thought that the rash was a hypersensitivity reaction to the antibiotic.