Bridget M. Bryer Groff, MD

A 4-year-old boy was referred for evaluation of refractory eczema that first appeared at 1 month of age.

An 18-year-old boy presented with a several-month history of an intermittent, very pruritic rash on his back that did not improve with topical corticosteroids. Physical examination revealed grouped erythematous papules with a few scattered small vesicles on his posterior neck and bilateral posterior shoulders at the location where his backpack frequently rubbed.

A healthy term infant born via normal vaginal delivery was noted at birth to have numerous small vesicles involving most of his face and upper chest. He was transferred to the neonatal ICU for suspicion of disseminated herpes simplex. On examination, the infant had small, 1- to 2-mm, superficial, clear vesicles that were confluent on the forehead, eyelids, nose, cheeks, neck, and upper back. A Tzanck test was negative for multinucleated giant cells.

A healthy 9-year-old girl presented with pruritic, darkly colored papules and linear lesions on the left side of her face. She had recently been on a hiking trip with her family. Examination revealed erythematous papules and linear streaks with an overlying black substance that resembled black lacquer paint.

A 7-year-old African American girl presented with an asymptomatic gray lesion beneath her right eye that had appeared before her first birthday. She was a healthy child with macular gray discoloration on the right infraorbital skin. There was no abnormal pigment noted on the conjunctiva.

This asymptomatic swelling above a 3-month-old boy's left eyebrow had not changed since birth. The 15 × 13-mm, soft, nontender, freely mobile nodule had no punctum, hair tuft, or other skin anomaly. The infant was born at term and was otherwise healthy. At the parents' request, the nodule was excised without complications by a pediatric surgeon. Pathological findings showed lamellated keratin within the mass and surrounding pilosebaceous units opening into the mass, consistent with a dermoid cyst.