Joshua J. Sacha, DO

A 10-year-old boy presented with a persistent rash that began several months earlier as recurrent crops of papules and a few vesicles with crusting. Varicella was initially diagnosed, and the patient was treated unsuccessfully with over-the-counter drying lotions. The patient denied systemic symptoms and pruritus and was in his usual state of health otherwise. Review of systems, family history, and social history were unremarkable. There was no history of travel or new exposures during this period.

Numerous scattered, mildly erythematous, brownish papules were scattered over the trunk, upper extremities, buttocks, and upper thighs. Many were slightly scaly and several had developed an eschar. The patient also had multiple areas of postinflammatory hyperpigmentation and a few varioliform scars. Other examination findings were normal.