Barbara Wilson, MD

A 5-year-old girl presented with a 2-day history of a widespread pruritic rash that began while the family was on vacation. The rash appeared suddenly as small pink macules and progressed to papules and pustules. Her brother had a similar-appearing but milder rash. She denied fever, chills, or constitutional symptoms. On further questioning, her father reported that she and her brother had been in a hot tub at their vacation home.

This tender lesion on the right cheek of a 4-year-old white girl had appeared shortly after her birth. It had subsequently enlarged for about 3 years before stabilizing. Physical examination revealed an erythematous arcuate plaque with a slightly thickened border that extended from the right oral commissure onto the right cheek. There was no family history of similar lesions, and the child was otherwise healthy.