Dermatology

A healthy 3-year-old girl presents for evaluation of light brown spots on her trunk and extremities that have appeared over the last 2 years. The spots are not symptomatic but the girl’s parents are worried that she could have neurofibromatosis.

A 3-month-old boy presents for evaluation of a diffuse asymptomatic rash that began on his scalp and skin creases 6 weeks ago and has spread over his trunk and extremities. This week he has begun to scratch at his neck and abdomen.

A healthy 14-year-old girl with a progressive asymptomatic rash on her arms, legs, trunk, and face presents for evaluation. She was treated for eczema with minimal improvement.

A healthy 12-year-old girl presents to the clinic with 2 days of low-grade fever and enlarging, painful, tense bullae on both hands. She had recently been diagnosed with streptococcal pharyngitis and was being treated with oral cefixime.

A healthy 11-year-old boy is brought to the office for evaluation of asymptomatic reticulated rash that started on his ankles 3 weeks ago and since has spread to his shins and the tops of both feet. He is on no medications and has had no history of trauma or recent illness. What's the diagnosis?

The parents of a 2-month-old boy return to the office for a well-child visit. The infant has a history of hypotonia and poor head control but is growing normally. His parents noted streaky patterns of hypopigmentation over his trunk and extremities shortly after birth and felt they were likely just “birthmarks.”

A 16-year-old girl presents to the clinic for acne follow-up and mentions that her palms wrinkle significantly after only a few minutes of immersion in water. She is otherwise well and has no significant past medical history.

An 8-year-old boy is brought to the office for evaluation of a persistent itchy rash on his extremities, trunk, and face. Although the rash has been present for longer than 3 months, individual skin lesions change from hour to hour and occasionally the rash clears completely only to recur several hours later. He is otherwise healthy with no known allergies, changes in diet, medication use, or recent illness.

A previously healthy 8-year-old boy presents to the dermatology clinic with a progressively worsening elbow rash over the course of the last week. The rash does not itch. He spent the previous weekend sailing on the Chesapeake Bay. His pediatrician prescribed a course of cephalexin as well as a trial of topical antiviral ointment, neither of which improved the rash. The patient denies any other new exposures. 

A landmark observational study is the first to report on the effect of ultraviolet-free blue light therapy on allergic skin disease in newborns.

New research examined the potential role of Gram-negative skin bacteria in the pathogenesis and exacerbation of eczema, and their effectiveness to treat it.

Children with psoriasis may have higher rates of associated medical comorbidities. Newest recommendations say such kids should be screened for these risk factors.

The mother of a healthy 4-week-old boy brings him to the office for evaluation of a small pit on the medial canthus of the left eye, noted since birth. There is constant drainage of tears onto the left side of his face and exudate on the bottom of the left medial canthus.

An anxious mother brings her healthy 4-month-old daughter for evaluation of itchy pustules on both hands and feet. The eruption has persisted despite 2 courses of permethrin for scabies. The infant also was diagnosed with hand-foot-and-mouth syndrome and dyshidrotic eczema, but neither of these diseases fit clinically.

The worried mother of an 11-year-old boy arrives at the office for evaluation of an asymptomatic bumpy rash that appeared suddenly in his right groin a month ago, and that has now extended all the way down to his right ankle. What's the diagnosis?

Adding emollients to bath water for eczema relief doesn’t help improve the condition, but costs a lot more than topical treatments.

Many parents and professionals have these misconceptions about allergies and other unusual findings.

A 16-year-old boy develops a diffuse, rapidly progressive eruption on his trunk, face, and extremities 4 days after starting oral amoxicillin for presumed strep throat. He presents to the emergency department (ED) where Stevens-Johnson syndrome is considered. The ED physician notes no mucous membrane involvement.

A 9-year-old boy presents for evaluation of white spots on his hands, elbows, knees, and legs. There is also a ring around a mole on his back. The patient’s parents first noted areas of depigmentation on his trunk and extremities, and his lesions have spread particularly in areas of trauma. The lesions were most noticeable in the summer when tanning increased the contrast between the involved and uninvolved areas of his body.

An 11-month-old boy was brought to the doctor by anxious parents for the evaluation of persistent diaper dermatitis. Despite trying multiple barrier creams and over-the-counter antifungal products, the rash did not resolve.

Following an uncomplicated pregnancy, labor, and delivery, a healthy 13-day-old girl presents for evaluation with a 2-day history of firm, violaceous nodules on her mid-upper back and right arm just above the axilla.

A healthy full-term newborn presented with a prominent sacral dimple within an oval patch. Ultrasound showed no evidence of spinal anomalies, and the child was discharged home. Three days later, the patch became elevated, red, and moist appearing, and she was brought to the emergency department (ED) for further evaluation of the “growing blister.”

We know you love a diagnostic challenge. Can you crack these 6 puzzling cases?

The parents of a healthy 5-month-old boy bring him to the office for evaluation of an enlarging yellowish nodule on the back of his right thigh. It started as a pink macule several months ago and became yellow and lumpy over the last month. The infant was born at term and has grown and developed normally. His parents deny any trauma, but report occasional bleeding from the surface of the nodule. They deny any new medications or outdoor exposures. There is no history of new topical skin products.

Eczema affects around 11% of children overall, but only about half of minority children with severe eczema are treated for the condition. A new study looks at why these children are overlooked.

For Contemporary Pediatrics, Dr Bobby Lazzara discusses a large retrospective cohort study published in the Journal of the American Academy of Dermatology that examined whether children with pediatric psoriasis are at increased risk of cancer and discusses 2 caveats to the findings.

A 16-year-old girl presents for evaluation of an asymptomatic brown rash over her central chest and back that developed over the preceding 6 months. She is embarrassed by the appearance.

The mother of a healthy 11-year-old boy brings him to the office for help to clear a rash that has persisted around his mouth for 3 months. Although the boy rarely licks his lips, he does not use lip products and has not changed his dental products.

The mother of a healthy 5-year-old girl brings her to the office for evaluation of 2 itchy plaques on her right ankle that have worsened over the last 10 days despite treatment for possible tinea corporis with topical clotrimazole 1% ointment and hydrocortisone 2.5% ointment. A fungal culture is pending.

A healthy 9-year-old female presents with a 1-day history of fever, progressive rash, conjunctivitis, and superficial oral ulcers.